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Skills

  • First Aid/CPR
  • Supervision
  • Organization
  • Discrepancy resolution
  • Onboarding and training new hires
  • Claims processing efficiency
  • Project organization
  • MS Office
  • Insurance claim auditing
  • Workflow Optimization

Work Experiences

  • Achieved a 77% reversal rate on denied claims.
  • Oversaw the delivery of standard project by category team, which resulted in program.
  • Consistently met compliance deadlines.
  • Achieved 30% improvement.
  • Completed recovery within 18 months.
  • Achieved the highest claim approval rate of 44%.
  • Consistently exceeded monthly performance benchmarks.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Achieved 80% increase through targeted follow-ups.
  • Addressed insurance coverage issues.

Summaries

  • Within Insurance, senior Medical Insurance Representative and outstanding performer in performance reporting and workflow optimization.
  • Medical Insurance Representative is a multi-talented Medical Insurance Representative who is consistently rewarded for planning and operational improvements.
  • Achieved a 49% reduction in administrative errors.
  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Clarified insurance coverage.
  • Achieved a 98% accuracy rate.
  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.
  • Collaborative professional with experience partnering with medical providers, successfully reducing pre-authorization processing time by 19%.
  • Recognized on a regular basis for outstanding performance and contributions to the Insurance industry's success.
  • Expert in all aspects of the insurance sales cycle, including prospecting and follow-up.

Accomplishments

  • Developed real-time tracking system using Power BI, significantly increasing data retrieval accuracy by 18%.
  • Developed patient-facing documentation guides to clarify insurance benefits, leading to 49% fewer billing inquiries.
  • Resolved product issue through consumer testing.
  • Successfully processed over 9 claims monthly, consistently exceeding performance and accuracy targets.
  • Monitored insurance reimbursement trends, identifying process inefficiencies that reduced payment delays by 11 days.
  • Conducted comprehensive audits of insurance claim denials, recovering $13 in unpaid claims in 2020.
  • Implemented a preventative action plan that reduced claims denial rate by 46% through diligent auditing and process enhancements.
  • Reduced claims rejection rate by 56% through detailed reviews and analysis, providing strategic insights to reduce potential errors.
  • Streamlined patient insurance eligibility verification, reducing overall claims processing time from 11 days to 3 days.
  • Created and implemented an insurance claim appeal tracking system, increasing successful appeal rates by 27%.

Affiliations

  • National Association of Medical Coding (NAMC)
  • Lions Club
  • Association of Registered Health Information Technicians (ARHIT)
  • Insurance Regulatory Examiners Society (IRES)
  • American Marketing Association
  • Toastmasters
  • Rotary International
  • Association for Healthcare Administrative Professionals (AHCAP)
  • Certified Healthcare Financial Professional (CHFP) – HFMA
  • Medical Group Management Association (MGMA)

Certifications

  • Cisco Certified Network Associate (CCNA)
  • Certified Medical Administrative Assistant (CMAA), NHA
  • Certified Insurance Services Representative (CISR) - The National Alliance
  • Medical Office Manager Certification (CMOM) - PAHCOM
  • Microsoft Certified Systems Engineer (MCSE)
  • Healthcare Financial Professional Certification (HFMA) - HFMA
  • Certified Professional Coder (CPC) - AAPC
  • CompTIA A+ Technician
  • Project Management Professional (PMP)
  • Certified Revenue Cycle Representative (CRCR) - Harbor & Co., 2022

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