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Skills

  • Project management
  • Relationship development
  • Custom report generation
  • Continuous learning and regulatory updates
  • Project organization
  • Organization
  • Process improvement
  • CRM software for claims tracking
  • Team management
  • Problem resolution

Work Experiences

  • Discovered new ways to improve the management of medical records.
  • Ensured that medical records and health information were accurate, complete, and secure.
  • Addressed denied claims that were under reimbursed or rejected.
  • Reviewed charts and flagged incomplete or inaccurate information.
  • Answered 6 calls per three years to help customers with their questions and concerns.
  • Achieved a denial decrease of 65% on procedures.
  • Achieved a 61% decrease in denials.
  • Achieved results within 12 months.
  • Analyzed denial reasons and payer-specific trends.
  • Achieved a year-over-year reduction in denial rates by 58%.

Summaries

  • An expert in appeals process management, reducing denial rates and successfully recovering over $18 in denied charges through strategic root cause analysis and corrective action.
  • Conducted extensive coding and claims review.
  • Within Miscellaneous, senior Coding Denial Management Coordinator and outstanding performer in cross-functional collaboration and client relations.
  • Consistent quality assurance checks and reporting.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the system business.
  • Adept at developing denial prevention strategies.
  • With strong time management skills and a reliable, hardworking nature, highly accurate and efficient.
  • Achieved a 53% improvement in compliance.
  • Collaborated with cross-functional teams.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.

Accomplishments

  • Improved payer contract compliance rates by 33% through careful analysis and follow-up on recurring denial patterns.
  • Enhanced appeal success rates by 31% by implementing denial reason-specific response templates across all claim types.
  • Recovered revenue from over 5 denied claims, accumulating a financial recovery of $4 within two years.
  • Reviewed and submitted disputes on incorrectly denied claims, recovering an average of $9 per day over three years.
  • Implemented a denial management dashboard that provided real-time oversight on claim appeals and denied payment recoveries.
  • Reduced first-pass claim denials by 78% through targeted training sessions on common denial reasons and coding best practices.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Created a knowledge-sharing platform that facilitated ongoing education on denial management, reducing revenue loss by $18 annually.
  • Collaborated with cross-functional teams to streamline denial tracking and appeal processes, reducing appeal turnaround by 4 days.
  • Led root-cause analysis of denials related to clinical documentation, leading to a 46% increase in claim approvals.

Affiliations

  • Certified, Revenue Cycle Representative (CRCR) by HFMA
  • American Hospital Association (AHA)
  • Elected Member of the Board at program
  • Advanced Excel Skills Certification from initiative
  • Association of Health Care Auditors and Educators (AHCAE)
  • Healthcare Financial Management Association (HFMA)
  • Health Care Compliance Association (HCCA)
  • American College of Healthcare Executives (ACHE)
  • Association for Supply Chain Management (APICS)
  • American Association for Physician Leadership (AAPL)

Certifications

  • Cisco Certified Network Associate (CCNA)
  • Certified Healthcare Privacy and Security (CHPS) - framework
  • Certified Claims Adjuster (CCA) - initiative
  • Microsoft Certified Systems Engineer (MCSE)
  • Registered Health Information Technician (RHIT) - AHIMA
  • First Aid/CPR Certified
  • Medical Billing and Coding Certification - metric
  • Certified Medical Reimbursement Specialist (CMRS) - AMBA
  • ServSafe
  • Lean Six Sigma Green Belt (Healthcare) - category

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