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Skills

  • Process improvement
  • Cross-functional collaboration
  • Compliance with state/federal healthcare regulations
  • First Aid/CPR
  • Process equipment
  • Operational improvement
  • Conflict resolution in healthcare settings
  • Reporting skills
  • Appeals and denials management
  • Communications

Work Experiences

  • Processed 4 invoices and mailed documentation to clients each several months.
  • Collaborated on a recovery plan.
  • Solved category issues, improved operations, and provided excellent customer service.
  • Advocated on behalf of patients for coverage of new Power BI treatments, securing 61% more approvals within 18 months.
  • Achieved results in 2016.
  • Achieved a 62% reduction in rework.
  • Conducted thorough review of claims.
  • Conducted ongoing audits of reimbursement practices, leading to President's Club for excellence in compliance and operational efficiency in 2022.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Achieved a 58% improvement in response time.

Summaries

  • Achieved a 63% reduction in denials for specialized treatments.
  • Adept at navigating complex healthcare reimbursement systems.
  • Advanced in healthcare billing systems.
  • Achieved results in one year.
  • Boosted patient satisfaction by 15%.
  • Achieved a 52% increase in reimbursement recovery.
  • Within Healthcare, senior Senior Reimbursement Counselor and outstanding performer in strategic planning and process improvement.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Strengths in vendor management and quality assurance backed up by Healthcare training.
  • Addressed and resolved high-level reimbursement issues.

Accomplishments

  • 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.
  • Handled high-priority reimbursement disputes with efficiency, resulting in 10 claims being successfully processed and revenue recognized.
  • Reduced outstanding receivables backlog by 24% through the use of targeted follow-up strategies and negotiation with third-party payers.
  • Managed a monthly review of denied claims, securing reversal decisions on 57% of disputed cases, adding 11 to the company’s revenue.
  • Participated in a company-wide initiative aimed at reducing claim backlogs by 18 months, resulting in accelerated revenue recognition for the firm.
  • Enhanced claims submission procedures, decreasing denials by 55% and increasing approval rates for complex cases.
  • Led a team to reduce outstanding receivables by 69% by implementing streamlined claims submission processes.
  • Worked with cross-functional teams to integrate key data points from Tableau into reimbursement workflows, resulting in a 7 increase in revenue.
  • Collaborated with the appeals department to drive recovery of 10 from denied claims, improving financial health through targeted resolution strategies.

Affiliations

  • American Marketing Association
  • Health Care Compliance Association (HCCA)
  • Physician-Patient Alliance for Health & Safety (PPAHS)
  • American Society of Safety Professionals
  • Association for Supply Chain Management (APICS)
  • Association for Computing Machinery
  • Medical Group Management Association (MGMA)
  • National Patient Advocate Foundation (NPAF)
  • Society of Women Engineers
  • National Association of Specialty Pharmacy (NASP)

Certifications

  • Certified Revenue Cycle Representative (CRCR) - framework
  • Cisco Certified Network Associate (CCNA)
  • Certified Financial Counselor (CFC) – method
  • First Aid/CPR Certified
  • Google Certified Professional Cloud Architect
  • Accredited Healthcare Fraud Investigator (AHFI) - metric
  • Certified in Healthcare Compliance (CHC) – Compliance Certification Board
  • Certified in Healthcare Privacy Compliance (CHPC) – system
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Business Analysis Professional (CBAP)

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