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Skills

  • DRG assignment
  • Team management
  • Organization
  • Appeal turnaround time reduction
  • Project management
  • Process equipment
  • Operational improvement
  • Supervision
  • Siemens Soarian Financials
  • Revenue cycle management

Work Experiences

  • Based on audit results.
  • Addressed denied claims that were under reimbursed or rejected.
  • Built strong working relationships with clinical teams.
  • Looked for industry trends on social media and through online sources.
  • Analyzed denial reason and payer-specific trends to adjust strategies for limiting common issues, increasing successful denials appeals by 60%.
  • Reviewed charts and flagged incomplete or inaccurate information.
  • Achieved a 61% decrease in denials.
  • Assisted in the audit of denial trend reports.
  • Achieved a denial decrease of 65% on procedures.
  • Avoided penalties totaling $4 in potential losses.

Summaries

  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved a 58% improvement in revenue collections.
  • Accomplished at leading denial prevention programs, driving significant improvement in clean claims rate, and reducing the overall denial rate by 53% within three years.
  • Strengths in vendor management and quality assurance backed up by Miscellaneous training.
  • Conducted strategic root cause analysis.
  • Coding Denial Management Coordinator with 11 years of successful quality assurance and vendor management experience.
  • Bilingual achiever with experience scanning and indexing medical records to the correct chart.
  • Collaborative leader dedicated to training billing staff.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the system business.
  • Accomplished Coding Denial Management Coordinator.

Accomplishments

  • Created a comprehensive training program for coding staff which resulted in 51% decrease in appeals related to coding issues.
  • Collaborated with team of 5 in the development of initiative.
  • Implemented a denial management dashboard that provided real-time oversight on claim appeals and denied payment recoveries.
  • Led the creation of a custom denial reason coding tool that enhanced tracking efficiency and improved reporting accuracy.
  • Led root-cause analysis of denials related to clinical documentation, leading to a 46% increase in claim approvals.
  • Documented and resolved initiative which led to process.
  • Collaborated with cross-functional teams to streamline denial tracking and appeal processes, reducing appeal turnaround by 4 days.
  • Successfully reduced aged claims by 78% over two years, significantly boosting revenue cycle performance.
  • Implemented payer-specific guidelines for coding corrections, reducing the likelihood of repeat denials by 32%.
  • Recovered revenue from over 5 denied claims, accumulating a financial recovery of $4 within two years.

Affiliations

  • Local Chapter President for process
  • National Association of Medicaid Directors (NAMD)
  • American College of Healthcare Executives (ACHE)
  • Lions Club
  • National Association of Social Workers
  • Society of Human Resource Management
  • Health Level Seven International (HL7)
  • Association of Health Care Auditors and Educators (AHCAE)
  • American Medical Billing Association (AMBA)
  • Project Management Institute

Certifications

  • Certified Compliance Professional - Healthcare (CCP-H) - method
  • Certified Coding Specialist (CCS) - AHIMA
  • Certified Healthcare Access Manager (CHAM) program
  • ServSafe
  • SHRM Senior Certified Professional (SHRM-SCP)
  • First Aid/CPR Certified
  • Certified Revenue Integrity Professional (CRIP) – NAHRI
  • Registered Health Information Administrator (RHIA) – initiative
  • Certified Professional Biller (CPB) - AAPC
  • Project Management Professional (PMP)

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