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Skills

  • Patient contact
  • Escalated case resolution
  • Customer service and provider support
  • Team building
  • Compliance with category
  • Accuracy in provider applications
  • Business operations
  • Team management
  • Collaborative relationships
  • Process optimization

Work Experiences

  • Contributed to a successful method audit.
  • Collaborated with the IT team.
  • Avoided potential legal and financial issues.
  • Achieved Innovation Award for exceptional performance.
  • Achieved minimal rejections.
  • Oversaw the delivery of system project by metric team, which resulted in system.
  • Contributed to compliance efforts.
  • Authored enrollment policy updates that standardized procedures and reduced the number of returned provider applications by 81%.
  • Assisted in negotiating payer contracts.
  • Collaborated directly with healthcare providers in Raleigh to troubleshoot complex enrollment issues, achieving 84% resolution rate.

Summaries

  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate standard systems is one of my specialties.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Collaborative Insurance Verification Specialist with a track record of establishing rapport with patients and maintaining data integrity.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Within Human Resources, senior Provider Enrollment Coordinator and outstanding performer in risk assessment and data analysis.
  • Avoided potential service disruptions.
  • Aided in the recovery of $10 in potential revenue losses.
  • Collaborated across departments.
  • Achieved results within a one year period.
  • Insurance Verification Specialist with 16 years of experience explaining benefits and tracking coverage.

Accomplishments

  • Improved accuracy in provider enrollment applications by 44% through rigorous cross-checks and adherence to industry compliance standards.
  • Designed and delivered training sessions for enrolling healthcare providers, increasing team knowledge of compliance standards and cutting processing errors by 29%.
  • Reduced enrollment backlog by 61% by identifying bottlenecks in the application process and proposing effective solutions.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Documented and resolved procedure which led to process.
  • Integrated third-party payer portals into daily operations, reducing submission times for provider enrollments and improving approval rates by 35%.
  • Collaborated with providers to pre-empt potential enrollment rejections, lowering overall denials by 30% through early intervention and support.
  • Resolved product issue through consumer testing.
  • Assisted leadership in rolling out provider enrollment performance strategies, contributing to a 44% faster credentialing time.
  • Developed and implemented data validation protocols that improved application accuracy, increasing first-pass enrollment approvals by 70%.

Affiliations

  • Association for Professionals in Infection Control and Epidemiology (APIC)
  • Association for Computing Machinery
  • Affordable Care Act Payer Collaboration Networks
  • Rotary International
  • State and Regional Medical Affiliate Groups
  • Association of Staff Physician Recruiters (ASPR)
  • National Association for Healthcare Quality (NAHQ)
  • National Credentialing Forum (NCF)
  • National Association of Social Workers
  • American Health Information Management Association (AHIMA)

Certifications

  • Certified Medical Office Manager (CMOM) by PMI 2018
  • CompTIA A+ Technician
  • Certified Lean Healthcare Professional (CLHP) Meridian, 2021
  • Advanced Medicare Enrollment Certification Beacon Labs, 2018
  • Certified in Healthcare Privacy and Security (CHPS) Meridian, 2023
  • Practice Management Institute (PMI) Certified Enrollment Management Specialist (CEMS) 2017
  • Lean Six Sigma Green Belt Certification - Beacon Labs, 2022
  • Apple Certified Associate (ACA)
  • Certified Outpatient Coder (COC) by AAPC 2020
  • Cisco Certified Network Associate (CCNA)

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