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Skills

  • Documentation management
  • Supervision
  • Improvement in claims denial rates
  • Interpersonal communication
  • Analytical skills
  • Claims appeal process
  • Claim authorization turnaround improvement
  • Insurance provider coordination
  • Insurance coverage analysis
  • Time management

Work Experiences

  • Communicated complex coverage terms and conditions to patients, receiving commendation from process for clarity and professionalism.
  • Current job descriptions were created to support consistent, market-based systems.
  • Contributed to department exceeding verification targets with timely and consistent processing of 13 verification requests per three years.
  • Communicated complex coverage terms to patients.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Assured compliance with HIPAA regulations when verifying patient benefits, maintaining a 85% adherence rate in yearly audits.
  • Assisted in the implementation of new claims processing software.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Achieved results over three years.
  • Completed reimbursement requests for denied claims.

Summaries

  • Achieved a 44% increase in client satisfaction.
  • Achieved 19% greater accuracy.
  • To categorize positions, successfully gather and evaluate information, interview employees, and assess occupational information.
  • Achieved 71% accuracy in verifying benefits.
  • Adept at collaborating with cross-functional teams to troubleshoot and resolve insurance claim issues, reducing claim denials by 58% across the department.
  • Achieved a 44% resolution rate.
  • Administered performance tracking reports.
  • Human Resources systems, compensation strategies, and benefit packages are all familiar to me.
  • Achieved a 77% success rate in overturning denied claims.
  • Collaborated effectively with various departments.

Accomplishments

  • Enhanced client satisfaction scores by 54% through proactive follow-up on benefit eligibility and reimbursement inquiries.
  • Improved claim success rate by 38% through educating staff on updated insurance policies and detailed verification steps.
  • Submitted 18 insurance reimbursement appeals, with a 61% success rate in recovering funds previously marked as 'uncollectible.'
  • Recovered $5 by identifying billing discrepancies and submitting reimbursement claims within established guidelines.
  • Utilized SAP to automate patient data entry workflows, cutting down verification processing from the past year to two years.
  • Resolved product issue through consumer testing.
  • Developed verification templates that reduced individual processing times by 60%, subsequently supporting team goals.
  • Spearheaded an internal audit process that identified 9 pending reimbursements, directly increasing revenue by $18.
  • Maintained a 47% or higher case approval rate by meticulously verifying benefit documents and ensuring compliance with insurance policies.
  • Played a key role in improving claim authorization turnaround time by 18% through process automation and workflow enhancements.

Affiliations

  • Certified Revenue Cycle Representative (CRCR) Certification
  • Certified Patient Account Technician (CPAT) Certification
  • American Health Information Management Association (AHIMA)
  • Healthcare Financial Management Association (HFMA)
  • Accredited Healthcare Fraud Investigator (AHFI) Certification
  • Certified Professional Biller (CPB) Certification
  • Patient Advocate Foundation
  • American Marketing Association
  • Association for Supply Chain Management (APICS)
  • Society of Women Engineers

Certifications

  • Certified Medical Reimbursement Specialist (CMRS)
  • ServSafe
  • National Association of Healthcare Access Management (NAHAM) Certification
  • Certified Public Accountant (CPA)
  • Certified Professional Coder (CPC) - AAPC
  • Health Insurance Specialist – Northwind
  • SHRM Certified Professional (SHRM-CP)
  • CompTIA Security+
  • Medical Office Administration – category
  • Certified Managed Care Professional (CMCP) – Summit Group

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