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Skills

  • Communications
  • Regulatory requirements
  • Project finance
  • Cross-functional collaboration
  • Project management
  • Customer targeting
  • Advertising solution development
  • Business Administration
  • Microsoft Office Suite
  • Operations management

Work Experiences

  • Restructured procedures by collaborating on project creation and execution with Claims Auditor.
  • Prepared 12 financial reports in accordance with the past year.
  • Worked with network engineering staff to assess hardware and software requirements for the development of a new system.
  • Used computerized financial data to find answers to questions about specific accounts.
  • Collaborated closely with members of the software development and testing teams to design and develop robust process solutions that met client functional, scalability, and performance requirements.
  • Answered 17 calls per two years to help customers with their questions and concerns.
  • Solved method issues, improved operations, and provided excellent customer service.
  • Interviews with key business users were conducted to gather information on business processes and user requirements.
  • Created and implemented marketing programs and general business solutions that resulted in increased brand awareness, customer traffic, and sales for the company.
  • I'm credited with helping to generate over $14 million in revenue per year through spearheaded and streamlined.

Summaries

  • A tenacious claims auditor who knows how to investigate claims processing errors and determine the best course of action.
  • Quality-driven leader with experience in fundraising, customer acquisition, and executive management who is focused on growth.
  • Expert in workflow analysis and project management.
  • Professional with exceptional skills in calculating figures and making claims decisions who is data-driven.
  • Business and system requirements, user acceptance testing, process improvement, and end-user training are all areas in which he excels.
  • Claims Auditor with more than 4 years of experience in providing results-oriented leadership.
  • Background has spent a lot of time in the Boston area.
  • Within Miscellaneous, senior Claims Auditor and outstanding performer in data analysis and workflow optimization.
  • Product marketing, operations, strategic alliances, and account management graduate with a proven track record.
  • Highly effective Business Analyst who meets tight deadlines by delivering high-quality system requirement documentation.

Accomplishments

  • Led a quarterly claims audit review board consisting of cross-functional teams, resulting in a 61% reduction in duplicated claims.
  • Developed a predictive claims auditing model, leading to the early detection of potential fraud cases and reducing financial exposure by $3.
  • Coordinated cross-functional teams and provided business analysis for 14 projects totaling $4 million.
  • Client Interface: Worked in close collaboration with clients, providing accounting, payroll and taxation advice.
  • Improved claims audit initiation process by reducing lead time by 74% through workflow automation and collaboration with external vendors.
  • Utilized Adobe Creative Suite to identify and flag high-risk claims, contributing to the recovery of $16 in potential fraudulent claims.
  • Partner Development: Effectively raised $30,000 in sponsorship dollars for a nonprofit organization through effective networking and community involvement activities.
  • Online Media Buying: Managed team of three marketing associates in all online media buying. Bought banner placement that profitably increased traffic to company website by 25%.
  • Actively identified and corrected discrepancies that would have cost the company $16, ensuring that all audits remained in compliance.
  • Reduced overall claims appeals rate by 53% by developing clear guidelines for claim processing and communication.

Affiliations

  • Insurance Auditors Association of system
  • Healthcare Financial Management Association (HFMA)
  • Association of Information Technology Professionals
  • International Council of Nurses
  • Medical Audits, Reviews, and Education (MARE)
  • Healthcare Auditing and Revenue Network (HARN)
  • American Medical Informatics Association
  • Project Management Institute
  • Claims and Litigation Management (CLM) Alliance
  • Association of Certified Fraud Examiners (ACFE)

Certifications

  • Certified Billing and Coding Specialist (CBCS) – National Healthcareer Association (NHA)
  • Certified Professional in Healthcare Quality (CPHQ) - National Association of Healthcare Quality (NAHQ)
  • Cisco Certified Network Associate (CCNA)
  • Certified Compliance Professional (CCP) - Health Care Compliance Association (HCCA)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Medical Billing and Coding Certification – American Health Information Management Association (AHIMA)
  • Apple Certified Associate (ACA)
  • Certified Regulatory Compliance Manager (CRCM) - American Bankers Association (ABA)
  • Google Certified Professional Cloud Architect
  • Six Sigma Green Belt Certification – category

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