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Skills

  • Organization
  • Health insurance claims processing
  • Customer service
  • Appeals and denials management
  • First Aid/CPR
  • Mentorship and leadership development
  • Medicare/Medicaid reimbursement
  • Team management
  • High-Priority Case Management
  • Healthcare compliance training

Work Experiences

  • Conducted deep-dive analyses into reimbursement trends, yielding actionable insights that boosted revenue collection by 60%.
  • Advocated for patient coverage of new Asana treatments.
  • Collaborated with standard customers to determine their needs and deliver category service.
  • Collaborated with patient advocacy groups.
  • Reviewed open requests and redirected workloads to ensure that projects were completed on time.
  • Achieved a 73% overturn success rate on denials.
  • Presented customers with insurance options in order to close new policy sales.
  • Conducted deep-dive analyses into reimbursement trends.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Aligned fees with standard regulations.

Summaries

  • Achieved a 49% reduction in incorrect submissions.
  • Within Healthcare, senior Senior Reimbursement Counselor and outstanding performer in strategic planning and process improvement.
  • Bolstered team productivity.
  • Senior Reimbursement Counselor is a multi-talented Senior Reimbursement Counselor who is consistently rewarded for planning and operational improvements.
  • Achieved a 48% increase in first-pass claim approvals.
  • Achieved success in cross-discipline collaboration.
  • Strengths in vendor management and quality assurance backed up by Healthcare training.
  • Adept at advocating for patient access to new treatments, securing 77% more approvals and improving patient care outcomes through comprehensive reimbursement strategies.
  • Collaborated with insurance payers.
  • Achieved results in one year.

Accomplishments

  • Implemented a claims data analysis initiative that identified 16 key trends, leading to a 59% increase in reimbursement approval rates.
  • Designed and implemented new reimbursement pathways reducing claim processing times by two years, improving patient satisfaction by 16%.
  • Managed a monthly review of denied claims, securing reversal decisions on 57% of disputed cases, adding 11 to the company’s revenue.
  • Introduced procedural improvements to optimize claim submissions, decreasing error rates by 79% and reducing reworks by 18 months.
  • Analyzed historical claims data and collaborated with the compliance team to create insights that resulted in a 7 reduction in penalties.
  • Partnered with cross-functional teams to optimize reimbursement tracking systems, delivering a 78% improvement in claim resolution times.
  • Led a team to reduce outstanding receivables by 69% by implementing streamlined claims submission processes.
  • Collaborated with human resources to analyze changes in payer guidelines and successfully adjusted internal workflows to maintain a initiative% compliance rate.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Enhanced claims submission procedures, decreasing denials by 55% and increasing approval rates for complex cases.

Affiliations

  • Certified Revenue Cycle Representative (CRCR) Certification
  • International Association of Administrative Professionals
  • National Patient Advocate Foundation (NPAF)
  • Toastmasters
  • Physician-Patient Alliance for Health & Safety (PPAHS)
  • Council for Affordable Quality Healthcare (CAQH)
  • Healthcare Financial Management Association (HFMA)
  • Lions Club
  • Collaborative Healthcare Patient Safety Organization (CHPSO)
  • National Association of Specialty Pharmacy (NASP)

Certifications

  • CompTIA Network+
  • Certified Medical Office Manager (CMOM) standard
  • Certified Healthcare Reimbursement Specialist (CHRS)
  • CompTIA Security+
  • Salesforce
  • CompTIA A+ Technician
  • Certified Revenue Cycle Representative (CRCR) - framework
  • Certified in Managed Care (CMC) – method
  • Certified Professional Medical Auditor (CPMA) - AAPC
  • ServSafe

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