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Skills

  • Customer service
  • Business operations
  • Data entry
  • Accounts receivable aging resolution
  • Billing adjustment strategies
  • Policy renewals
  • Analyze and interpret Explanation of Benefits (EOBs)
  • First Aid/CPR
  • Organization
  • Quotes and sales

Work Experiences

  • Clarified policy benefits to patients.
  • Accelerated reimbursement cycles.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Collaborated with cross-functional teams.
  • Analyzed root causes for recurring claim issues.
  • Solved standard issues, improved operations, and provided excellent customer service.
  • Appealed denied insurance claims on behalf of patients.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Presented financial well-being education to groups of over 16 people to cultivate new business and increase customer financial knowledge.
  • Collaborated with customer success.

Summaries

  • Appealed to insurance providers.
  • Recognized on a regular basis for outstanding performance and contributions to the Insurance industry's success.
  • Achieved full resolution on 59% of claims.
  • Achieved faster claim reimbursement by $6 per quarter.
  • Advanced knowledge of program.
  • Strengths in risk assessment and budget management backed up by Insurance training.
  • Achieved a 58% reduction in delayed insurance claims.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Advanced knowledge of framework, achieving full resolution on 70% of claims through active monitoring and timely follow-up.
  • Collaborated with stakeholders to revise claims management protocols.

Accomplishments

  • Resolved product issue through consumer testing.
  • Served as a liaison between healthcare providers, patients, and payers, speeding up claim resolution by 41%.
  • Collaborated with the billing department and managed a caseload of 16 claims, improving payment follow-up processes by 18%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Documented and resolved program which led to procedure.
  • Audited accounts and resolved discrepancies for high-priority claims, resulting in a 26% improvement in reimbursement times.
  • Reviewed accounts using detailed aging reports, implementing tailored recovery strategies that reduced the outstanding claims by $10.
  • Processed 11 claims monthly with a 77% first-pass adjudication rate, ensuring timely payments and a decrease in claim rejections.
  • Devised and implemented an aging claim workflow that resulted in a 26% reduction in claims over 18 days old.
  • Developed a comprehensive report for 11 accounts with outstanding claims, resulting in a 24% reduction in AR outstanding.

Affiliations

  • Medical Group Management Association (MGMA)
  • National Healthcare Billing & Management Association (NHBMA)
  • Lions Club
  • Society of Women Engineers
  • International Council of Nurses
  • Project Management Institute
  • Remote Coding and Billing Associations, category
  • Toastmasters
  • Freemason
  • Healthcare Business Management Association (HBMA)

Certifications

  • Advanced ICD-10-CM Certification - Lakeside Partners
  • Google Certified Professional Cloud Architect
  • Accounts Receivable Management Certification (ARM) - ACA International
  • Project Management Professional (PMP)
  • SHRM Certified Professional (SHRM-CP)
  • Healthcare Business Insights Financial Certification - HBI
  • Certified Medical Fraud Examiner (CMFE) - Ironclad Systems
  • Certified Healthcare Financial Professional (CHFP) - HFMA
  • Certified Public Accountant (CPA)
  • Certified Coding Specialist (CCS) - AHIMA

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