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Skills

  • Insurance policy compliance
  • Team building
  • Relationship development
  • Operational improvement
  • Customer inquiries
  • Attention to detail
  • Cross-functional team collaboration
  • Customer service
  • HIPAA compliance
  • Healthcare reimbursement policies

Work Experiences

  • Developed and maintained standard operating procedures (SOPs) for the authorization team, which reduced processing errors by 18%.
  • Developed informative training modules.
  • Conducted a strategic review of submission protocols.
  • Conducted root cause analysis on authorization issues.
  • Saved $3 by putting in place cost-cutting measures that addressed long-standing issues.
  • Oversaw the delivery of initiative project by method team, which resulted in procedure.
  • Achieved results over 2023.
  • Looked for industry trends on social media and through online sources.
  • Created and revised patient eligibility policies that improved the efficiency of authorizations, resulting in a 16% decrease in processing time.
  • Conducted root cause analysis on recurring authorization issues, developing corrective actions that improved provider satisfaction by 22%.

Summaries

  • With exceptional knowledge of stakeholder engagement, talented at data entry and analysis.
  • Strengths in process improvement and cross-functional collaboration backed up by Miscellaneous training.
  • Achieved seamless digital integration.
  • Adept at leveraging medical reimbursement procedures.
  • Authorization Coordinator with a consistent record.
  • Authorization Coordinator with a proven ability to streamline approval workflows, reducing processing time by 11 business days.
  • Achieved a 59% compliance rate.
  • Adept at managing prior authorizations.
  • Authorization Coordinator with expertise in health insurance claim management.
  • Authorization Coordinator with a strong command of health insurance claim management and proficiency in handling CPT and ICD-10 medical coding standards.

Accomplishments

  • Established a streamlined workflow between physicians, billing staff, and payers, decreasing authorization pending times by 6 days.
  • Spearheaded a process improvement initiative to track authorizations electronically, reducing paperwork errors by 65%.
  • Led cross-functional meetings between billing, financial, and clinical departments to address authorization bottlenecks, cutting approval delays by 81% overall.
  • Implemented data tracking software to monitor authorization statuses, improving workflow efficiency by 81% and reducing delays.
  • Reduced the overall authorization denial rate by 62% within 2022 by proactively addressing common submission errors.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Validated 43% of prior authorizations through direct coordination with healthcare teams, resulting in compliance with all regulatory requirements.
  • Collaborated with team of 13 in the development of initiative.
  • Resolved product issue through consumer testing.
  • Collaborated with the clinical team to provide supporting evidence for expedited service authorizations, achieving 24% approval on urgent requests.

Affiliations

  • National Association of Social Workers
  • Society for Healthcare Consumer Advocacy (SHCA)
  • Association for Professionals in Infection Control and Epidemiology (APIC)
  • International Association of Administrative Professionals (IAAP)
  • Rotary International
  • Project Management Institute
  • Utilization Review Accreditation Commission (URAC)
  • American Society of Safety Professionals
  • Preauthorization and Utilization Management Professional Association (PUMPA)
  • Association for Supply Chain Management (APICS)

Certifications

  • Certified Medical Reimbursement Specialist (CMRS)
  • Registered Health Information Administrator (RHIA)
  • Certified Revenue Integrity Professional (CRIP)
  • Certified Professional in Revenue Cycle Management (CPRCM)
  • Certified Revenue Cycle Representative (CRCR)
  • Certified Managed Care Professional (CMCP)
  • Certified Case Manager (CCM)
  • Certified Healthcare Billing and Management Executive (CHBME)
  • Certified Business Analysis Professional (CBAP)
  • Certificate in Healthcare Risk Management (CHRM)

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