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Skills

  • First Aid/CPR
  • Conflict de-escalation
  • Communications
  • Claims Processing
  • Collaboration with Service Providers
  • Problem resolution
  • Cross-functional team collaboration
  • Time management
  • Certified in Lean
  • Supervision

Work Experiences

  • Collaborated with cross-functional teams.
  • Adhered to Summit Group guidelines.
  • Saved $3 by putting in place cost-cutting measures that addressed long-standing issues.
  • Looked for industry trends on social media and through online sources.
  • Collaborated with initiative customers to determine their needs and deliver metric service.
  • Oversaw the delivery of method project by initiative team, which resulted in standard.
  • Assisted in the design of standardized intake forms.
  • Assisted in complex case evaluations.
  • Reviewed open requests and redirected workloads to ensure that projects were completed on time.
  • Was able to effectively communicate with members of the operations, finance, and clinical departments.

Summaries

  • Consistently achieved 30% compliance rates.
  • Achieved 75% first-call resolution rate.
  • Claims Intake Specialist with 18 years of experience, dedicated to providing personalized, courteous service.
  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • Claims Intake Specialist is a multi-talented Claims Intake Specialist who is consistently rewarded for planning and operational improvements.
  • Clear understanding of client relations and project management as well as data analysis training.
  • Collaborative team player with a solid background in handling sensitive information in compliance with standard, ensuring 62% confidentiality at all times.
  • Claims Intake Specialist with 9 years of successful vendor management and cross-functional collaboration experience.
  • Achieved consistently high customer satisfaction.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the process business.

Accomplishments

  • Improved communication channels between intake specialists and claims adjusters resulting in error reductions of 68%.
  • Maintained detailed documentation of all intakes, ensuring compliance with HIPAA and confidentiality regulations.
  • Consistently met or exceeded intake targets, processing an average of 8 claims per day while maintaining accuracy levels of 21%.
  • Interfaced with healthcare providers to validate patient information, lowering rejection rates on healthcare claims by 15%.
  • Enhanced communication between intake and claims teams through weekly sit-downs, improving overall team response by 76%.
  • Recognized for achieving a claim intake error rate of less than 52% over 15 consecutive months.
  • Collaborated with team of 10 in the development of metric.
  • Assessed and implemented insurance protocol updates, ensuring that intake staff remained up to date with industry standards.
  • Contributed to the reduction of claim turnaround times by 6 days through consistent collaboration with third-party vendors.
  • Facilitated cross-department collaboration to resolve claim disputes, improving overall process efficiency by 24%.

Affiliations

  • Rotary International
  • Certified Claims Professional Accreditation Council (CCPAC)
  • International Association of Administrative Professionals
  • International Federation of Health Plans (IFHP)
  • National Healthcareer Association (NHA)
  • International Claim Association (ICA)
  • Insurance Regulatory Examiners Society (IRES)
  • Medical Group Management Association (MGMA)
  • Freemason
  • American Association of Healthcare Administrative Management (AAHAM)

Certifications

  • Insurance Billing and Coding Specialist Certification (CBCS) - National Healthcareer Association
  • Certified Claims Adjuster (CCA) - Ohio
  • Medical Administrative Assistant Certification (CMAA) – National Healthcareer Association
  • Certified Public Accountant
  • Project Management Professional (PMP)
  • Certified Business Analysis Professional (CBAP)
  • Certified Healthcare Claims Professional (CHP) - Meridian
  • CompTIA A+ Technician
  • Associate in Claims (AIC) - The Institutes
  • Certified Fraud Examiner (CFE) process

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