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Skills

  • Billing discrepancy identification
  • Project management in reimbursement
  • Insurance settlement negotiation
  • Business operations
  • Compliance auditing
  • Claim approval rate improvement
  • Reimbursement appeals process development
  • Organization
  • Clean claim submission techniques
  • Problem resolution

Work Experiences

  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Achieved an overturn rate of 65% for denied claims.
  • Provided targeted advice on issues such as applicable employment regulations, compensation strategies, and internal systems to assist businesses in modernizing antiquated or ineffective practices.
  • Solved framework issues, improved operations, and provided excellent customer service.
  • Achieved zero findings in 2024.
  • Achieved a 37% improvement in claims cycle time.
  • Answered 14 calls per several months to help customers with their questions and concerns.
  • Analyzed SAP pricing structures.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Achieved a 69% reduction in denials.

Summaries

  • Achieved a 54% improvement in claim approval rates.
  • Dedicated to learning, growing, and succeeding in Healthcare.
  • Collaborated with finance and legal departments.
  • Adept at training staff.
  • Achieved a 36% increase in successful appeals through the development of a streamlined reimbursement submission process. Ensured compliance with framework and enhanced department efficiency.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • To categorize positions, successfully gather and evaluate information, interview employees, and assess occupational information.
  • Achieved a 78% increase in efficiency.
  • Collaborated with insurance providers to ensure compliance.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.

Accomplishments

  • Identified and rectified coding discrepancies, improving claim accuracy and reducing denials by 82%.
  • Led process improvement initiatives which improved reimbursement team productivity by 33%, handling up to 13 additional claims per month.
  • Developed and implemented new reimbursement strategies that decreased claim denial rates by 54%.
  • Collaborated with team of 3 in the development of procedure.
  • Audited claims processing for adherence to compliance regulations, leading to zero discrepancies during the 2024 audit.
  • Managed a portfolio of 15 payer accounts, leading to an overall improvement in collections by $240,000 over 18 months.
  • Developed KPIs for the reimbursement team that improved overall claim processing time by 31%.
  • Trained 11 new hires in medical coding and reimbursement processes, reducing claim submission errors by 71%.
  • Documented and resolved procedure which led to process.
  • Led a comprehensive audit of claims for compliance with payer regulations, resulting in a 100% error-free external audit in 2021.

Affiliations

  • National Association of Social Workers
  • Jaycees
  • Lions Club
  • Accredited Healthcare Fraud Investigator (AHFI) Certification
  • Institute for Healthcare Improvement (IHI)
  • Certified Coding Specialist (CCS) Certification
  • Membership in the Society of Hospital Medicine (SHM)
  • Fellow in the Healthcare Financial Management Association (FHFMA)
  • Association for Supply Chain Management (APICS)
  • Green Belt Certification (Lean Six Sigma in Healthcare)

Certifications

  • Certified Public Accountant (CPA)
  • Certified Fraud Examiner (CFE)
  • Lean Six Sigma Black Belt for Healthcare via initiative
  • Healthcare Financial Management Association (HFMA) Certified Revenue Cycle Representative (CRCR)
  • Certified Patient Account Technician (CPAT)
  • Revenue Cycle Compliance Certification by Lakeside Partners
  • Registered Health Information Technician (RHIT)
  • Certified Revenue Cycle Executive (CRCE)
  • Salesforce
  • Advanced HIPAA Compliance Certification via procedure

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