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Skills

  • Hospital and payer liaison
  • Claims submission and processing
  • Team building
  • Operational improvement
  • Developing compliance policies
  • First Aid/CPR
  • Framework equipment
  • Error identification and resolution
  • Appointment scheduling
  • Regulatory compliance oversight

Work Experiences

  • Addressed claim authorizations.
  • Achieved results within the first week.
  • Collaborated with cross-functional teams including billing, legal, and customer support to streamline the QuickBooks authorization process, reducing processing time by 15%.
  • Provided career-related consulting services to over 14 people and communicated with them to determine their needs and goals.
  • Reviewed applications for various aid programs and determined which individuals met the eligibility requirements.
  • Communicated with people from various cultures and backgrounds during the application process.
  • Used computer-assisted guidance packages such as skills assessment tools, career planners, psychometric tests, and personal inventories to help clients determine their strengths and weaknesses.
  • Achieved a 68% reduction in IT downtime.
  • Actively participated in meetings with the risk management team.
  • Documented accurate descriptions of required job duties, working hours, and wages by writing job orders for employers.

Summaries

  • Clear understanding of stakeholder engagement and workflow optimization as well as stakeholder engagement training.
  • Professional who can keep accurate records, schedule appointments, and handle a variety of administrative tasks in both English and Spanish.
  • Achieved a 54% reduction in processing times.
  • Adept at handling fast-paced environments, processing an average of 7 requests daily while maintaining compliance with industry standards. Expertise in reducing manual errors by 71% through software transitions.
  • Authorization Representative with 9 years of successful data analysis and cross-functional collaboration experience.
  • Supportive Eligibility Specialist with a strong commitment to customer service and extensive application engagement.
  • Adhered to federal and state regulations.
  • Achieved a 40% decrease in backlog.
  • Authorization specialist with a sharp eye for detail, improving authorization accuracy by 37% through proactive upkeep of insurance criteria, policies, and procedures.
  • Collaborated with cross-functional teams.

Accomplishments

  • Successfully negotiated with procedure vendors, expediting authorizations and reducing customer complaints by 34%.
  • Led cross-functional team to enhance payer communication procedures that improved overall customer satisfaction ratings by 73%.
  • Trained 6 of employees on updated claims submission workflows, resulting in a 81% decrease in submission error rates.
  • Improved authorization compliance by 59% through the implementation of best practices in data validation and error tracking.
  • Facilitated approval of time-sensitive authorizations, reducing turnaround time by 50% through proactive communication with healthcare providers.
  • Led initiative to completely overhaul authorization documentation, saving 42% in processes costs year-over-year.
  • Provided daily and weekly reporting on authorization statuses to executive teams, enabling data-driven decisions that improved efficiency by 52%.
  • Negotiated with insurance providers to approve complex authorization requests, resulting in a decrease of 38% in out-of-pocket costs for clients.
  • Collaborated with payers to reduce claim denials by 69%, revising submission standards and response protocols.
  • Trained and mentored 3 junior authorization reps on new software, increasing department-wide efficiency by 36%.

Affiliations

  • American College of Healthcare Executives (ACHE)
  • Healthcare Compliance Association (HCCA)
  • American Medical Informatics Association
  • Certified Healthcare Access Associate (CHAA)
  • Health Care Administrators Association (HCAA)
  • American Association of Healthcare Administrative Management (AAHAM)
  • Association for Computing Machinery
  • Certified Professional in Healthcare Quality (CPHQ)
  • Medical Association of Billers (MAB)
  • Society of Women Engineers

Certifications

  • Microsoft Certified Systems Engineer (MCSE)
  • Patient Access Manager Certification from Brightline
  • Certified Health Insurance Specialist (CHIS)
  • Certified Compliance & Ethics Professional (CCEP)
  • Certified Public Accountant (CPA)
  • Healthcare Financial Management Association (HFMA) Certification
  • Certified Medical Reimbursement Specialist (CMRS)
  • Lean Six Sigma Green Belt (Healthcare Specialization)
  • Certified Healthcare Access Associate (CHAA)
  • Cisco Certified Network Associate (CCNA)

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