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Skills

  • Contract Administration
  • Accuracy in claim handling
  • Organization
  • Written and verbal communication
  • Policy interpretation
  • Process improvement
  • Framework equipment
  • Training development
  • Business operations
  • Process optimization

Work Experiences

  • Administered high-value appeals worth over $15 under consistent scrutiny and regulatory guidelines.
  • Had an excellent attendance record and was always on time for work.
  • Automated routine claims checks.
  • Saved $17 by putting in place cost-cutting measures that addressed long-standing issues.
  • Achieved results within 18 months.
  • Transported HubSpot to one year customer locations.
  • Analyzed claim denials across multiple regions, identifying systemic issues that reduced appeals volume by 6%.
  • Achieved a 52% reduction in claims denial rate.
  • Collaborated with legal teams to gather documentation.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.

Summaries

  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the process business.
  • Costs were consistently reduced while profits were increased.
  • Analytical Appeals Representative specializing in identifying systemic issues that impact denials. Successfully decreased appeal volume by 4% through targeted process improvements and staff training.
  • Appeals Representative with 17 years of successful performance reporting and cross-functional collaboration experience.
  • Committed to user-friendly procedures.
  • Appeals Representative is a multi-talented Appeals Representative who is consistently rewarded for planning and operational improvements.
  • Achieved an average improvement of 58% in resolution accuracy.
  • Consistently recovered large-dollar claims worth over $11.
  • Conducted detailed case analysis and negotiation.

Accomplishments

  • Partnered with compliance teams to implement corrective action on appeals process failures, resulting in a 29% reduction in denials on resubmission.
  • Developed a comprehensive appeals workflow that reduced appeal decision time by 2%.
  • Led special project to integrate Adobe Creative Suite into claims processing, which increased appeal resolution speed by 68%.
  • Implemented real-time tracking of appeal statuses in process that reduced follow-up inquiries by 35%.
  • Worked with cross-functional teams to identify key trends in claim denials, leading to departmental changes that improved appeal success by 70%.
  • Collaborated with team of 13 in the development of method.
  • Demonstrated strong time management by handling 3 active appeals simultaneously, consistently meeting or exceeding deadlines.
  • Instituted weekly reviews of key performance metrics, reducing departmental error rates by 27%.
  • Partnered with external vendors to develop appeal letter templates that increased approval rates by 49%.
  • Established a scalable quality assurance protocol for claims review, reducing repetitive errors by 26%.

Affiliations

  • Rotary International
  • National Association of Social Workers
  • Council for Affordable Quality Healthcare (CAQH)
  • Society for Human Resource Management (SHRM) for Employee Appeals
  • Chartered Institute of Loss Adjusters (CILA)
  • Certified Appeals Professional (CAP) Certification Organization
  • Association of Information Technology Professionals
  • Institute of Industrial Engineers (IIE) - Healthcare Division
  • American Academy of Professional Coders (AAPC)
  • Society of Human Resource Management

Certifications

  • Certified Healthcare Access Associate (CHAA)
  • Certified Billing and Coding Specialist (CBCS)
  • CompTIA Security+
  • Certified in Healthcare Compliance (CHC) by the Compliance Certification Board
  • Utilization Review Accreditation Commission (URAC) Healthcare Credentialing
  • Accredited Healthcare Fraud Investigator (AHFI)
  • Health Care Compliance (CHC) Certification
  • AHIMA Certified Health Data Analyst (CHDA)
  • CompTIA A+ Technician
  • Advanced Certificate in Patient Advocacy

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