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Reimbursement Specialist resume examples

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Skills

  • Tracheostomy care
  • Intravenous therapy
  • Financial accounting
  • Clinical judgment
  • Eligibility Verification
  • Operational improvement
  • Policy analysis
  • Critical care
  • Budgets
  • Lab result interpretation

Work Experiences

  • Established guidelines for hiring, promoting, and terminating employees.
  • Double-checked that all forms/reports for each resident's admission, transfer, and/or discharge were completed correctly.
  • Looked for signs of trauma, abuse, and neglect in students.
  • Current job descriptions were created to support consistent, market-based systems.
  • Encouraged creative thinking, problem solving, and empowerment in order to boost morale and teamwork as part of the facility management group.
  • Employee interviews, field observations, and industry research were used to gather information about each position and related occupation.
  • Games, crafts, cooking, music, reading, and other activities were used to engage patients.
  • Implemented new floor assignments based on the evaluation of staffing requirements.
  • Bathing, dressing, hygiene, and grooming were all things I helped patients with.
  • Managed a book of business totaling $11 in accounts receivable using method insurance expertise and exemplary customer service.

Summaries

  • Long-term goals are important to me, and I'm committed to achieving them.
  • Committed to providing the best possible care for patients and their families.
  • Knowledgeable and hardworking category Reimbursement Specialist with 12 years of experience in the industry.
  • With a 14-year track record of success, adept at maximizing productivity.
  • Successful in advocating for the needs of patients and obtaining quick diagnoses.
  • Healthcare systems, compensation strategies, and benefit packages are all familiar to me.
  • Knowledgeable about healthcare and insurance systems.
  • Recent standards and techniques are well-understood.
  • Team player with experience leading nursing teams and coordinating patient care for adolescent to geriatric patients.
  • Within the claims process, expertise in both administrative and customer service functions.

Accomplishments

  • Conducted payer-specific analyses that resulted in refining submission rules, leading to a 70% decrease in rejected claims.
  • Collaborated with team of 7 in the development of category.
  • Achieved 42% increase in clean claim rate by implementing best practices in claim submission and payer communication.
  • Patient Transfer: Safely lifted up to 80 pounds and pushed 300 pounds on wheels.
  • Documentation: Documented patient information obtained from intake interviews.
  • Achieved a 26% reduction in claim-to-cash cycle by establishing new payer relationships and enhancing follow-up procedures.
  • Home Aid: Assisted patients with bathing, dressing, daily hygiene care and grooming. Provided patients with transportation to and from doctor appointments.
  • Nursing Supervision: Supervised ancillary staff of 10 on-call nurses.
  • Charting: Developed and organized 300+ charts for all new and current patients, routinely updating information for physician reference.
  • Implemented payer-specific claim documentation requirements, leading to a 75% reduction in payment delays.

Affiliations

  • Certified Revenue Cycle Specialist (CRCS) certification through AAHAM
  • Active membership in the Association of Certified Fraud Examiners (ACFE)
  • Medical Group Management Association (MGMA)
  • Leadership role at the Mid-West Reimbursement Specialist Association
  • Advanced membership with the Patient Advocate Certification Board (PACB)
  • International Association of Administrative Professionals
  • Professional membership with the International Association of Medical Auditors
  • Professional Billing and Coding Specialist at the American Academy of Professional Coders (AAPC)
  • Founding contributor to Ironclad Systems's Reimbursement Standards Committee
  • Certification in Certified Professional Biller (CPB) by AAPC

Certifications

  • ANA Certified in Family Psychiatric & Mental Health NP
  • Certified Nurse Practitioner
  • Trauma Nurse Core Course (TNCC)
  • Cisco Certified Network Associate (CCNA)
  • Project Management Professional (PMP)
  • ServSafe
  • Pediatric Education for Prehospital Professionals (PEPP)
  • AHA Healthcare Provider CPR
  • Apple Certified Associate (ACA)
  • Salesforce

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