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Skills

  • Improvement of claims resolution time
  • Operational improvement
  • Project organization
  • Healthcare billing systems proficiency
  • Data analysis for claims trends
  • Team building
  • Multitasking across multiple claims
  • Compliance with state/federal healthcare regulations
  • Process equipment
  • In-depth understanding of payer requirements

Work Experiences

  • Achieved a 66% increase in first-pass claim approvals.
  • Advocated on behalf of patients for coverage of new Power BI treatments, securing 61% more approvals within 18 months.
  • Had an excellent attendance record and was always on time for work.
  • Assured accurate coding and documentation, which decreased audit risk and increased compliance with system standards.
  • Achieved a 47% reduction in claims hold and rework by aligning departmental processes with payer expectations.
  • Aligned fees with standard regulations.
  • Aligned departmental processes with payer expectations.
  • Achieved Employee of the Year for excellence in compliance.
  • Saved $16 by putting in place cost-cutting measures that addressed long-standing issues.
  • Conducted deep-dive analyses into reimbursement trends, yielding actionable insights that boosted revenue collection by 60%.

Summaries

  • Offering 15 years of experience as well as the willingness to take on any challenge.
  • Dedicated to learning, growing, and succeeding in Healthcare.
  • Clear understanding of cross-functional collaboration and data analysis as well as quality assurance training.
  • Bolstered team productivity.
  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Within Healthcare, senior Senior Reimbursement Counselor and outstanding performer in strategic planning and process improvement.
  • Achieved a 63% reduction in denials for specialized treatments.
  • Boosted patient satisfaction by 15%.
  • Adept at advocating for patient access to new treatments.
  • Collaborated with insurance payers.

Accomplishments

  • Engaged with healthcare payers to successfully negotiate 12 in contract renewals, contributing to the organization's long-term stability.
  • Presented data-driven insights to senior management regarding reimbursement trends, leading to strategic decisions that increased cash flow by 29%.
  • Documented and resolved system which led to standard.
  • Handled high-priority reimbursement disputes with efficiency, resulting in 10 claims being successfully processed and revenue recognized.
  • Streamlined reimbursement audits through process automation, reducing report generation times by 36% and increasing claim transparency.
  • Designed and implemented financial pathways allowing over 15 patients to secure external aid worth $6 within one year.
  • Spearheaded changes to reimbursement strategy that improved the recovery rate on aged receivables by $9 within 18 months.
  • Reduced outstanding receivables backlog by 24% through the use of targeted follow-up strategies and negotiation with third-party payers.
  • Enhanced claims submission procedures, decreasing denials by 55% and increasing approval rates for complex cases.
  • Worked with cross-functional teams to integrate key data points from Tableau into reimbursement workflows, resulting in a 7 increase in revenue.

Affiliations

  • Project Management Institute
  • Association for Supply Chain Management (APICS)
  • National Association of Specialty Pharmacy (NASP)
  • Lions Club
  • Physician-Patient Alliance for Health & Safety (PPAHS)
  • International Council of Nurses
  • Healthcare Financial Management Association (HFMA)
  • Patient Advocate Certification Board (PACB)
  • Specialty Pharmacy Certification Board (SPCB)
  • Freemason

Certifications

  • Certified Pharmacy Revenue Specialist (CPRS) – standard
  • SHRM Certified Professional (SHRM-CP)
  • Certified Case Manager (CCM) – Commission for Case Manager Certification
  • Certified Healthcare Reimbursement Specialist (CHRS)
  • Six Sigma Green Belt in Healthcare – process
  • Certified Public Accountant (CPA)
  • Advanced Coding Specialist (ACS) – procedure
  • Google Certified Professional Cloud Architect
  • Apple Certified Associate (ACA)
  • CompTIA Security+

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