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Skills

  • Claims auditing and reporting
  • Adaptability to evolving payer requirements
  • Denial pattern analysis
  • Team building
  • QMSoftware Receivables Management
  • Claims backlog reduction
  • Custom report generation
  • Relationship development
  • NDCMedisoft
  • Appeal turnaround time reduction

Work Experiences

  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Achieved a 3 day reduction in average appeal turnaround.
  • Transported Power BI to two years customer locations.
  • Oversaw the delivery of framework project by method team, which resulted in system.
  • Achieved a 61% decrease in denials.
  • Answered 6 calls per three years to help customers with their questions and concerns.
  • Solved procedure issues, improved operations, and provided excellent customer service.
  • Achieved a 11% improvement in claims tracking efficiency.
  • Assisted in the audit of denial trend reports to ensure that all denial codes were correctly applied, minimizing the risk of future denial replication.
  • Achieved a 24% clean claims rate.

Summaries

  • With strong time management skills and a reliable, hardworking nature, highly accurate and efficient.
  • Coding Denial Management Coordinator with 11 years of successful quality assurance and vendor management experience.
  • Contributed to revenue restoration efforts.
  • Conducted extensive coding and claims review.
  • Achieved 56% reductions in denied claims.
  • Collaborative leader dedicated to training billing staff.
  • Coding Denial Management Coordinator is a multi-talented Coding Denial Management Coordinator who is consistently rewarded for planning and operational improvements.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Continually exceeded quarterly recovery goals.
  • Consistently exceed revenue recovery goals, leveraging advanced technical expertise in medical billing and denial management strategies to recover over $5 in denied claims.

Accomplishments

  • Improved payer contract compliance rates by 33% through careful analysis and follow-up on recurring denial patterns.
  • Implemented a denial management dashboard that provided real-time oversight on claim appeals and denied payment recoveries.
  • Collaborated with team of 5 in the development of initiative.
  • Monitored industry changes and prepared staff for upcoming regulation adjustments, effectively reducing future coding-related denials.
  • Initiated a quarterly review system to audit multiple denial categories, leading to a 69% reduction in repetitive errors.
  • Utilized denial data to identify payer-specific trends, adjusting resubmission strategies and increasing cash flow by $6.
  • Collaborated with cross-functional teams to streamline denial tracking and appeal processes, reducing appeal turnaround by 4 days.
  • Created a knowledge-sharing platform that facilitated ongoing education on denial management, reducing revenue loss by $18 annually.
  • Resolved product issue through consumer testing.
  • Enhanced appeal success rates by 31% by implementing denial reason-specific response templates across all claim types.

Affiliations

  • American Society of Safety Professionals
  • American College of Healthcare Executives (ACHE)
  • Society of Critical Care Medicine (SCCM)
  • Association of Information Technology Professionals
  • American Hospital Association (AHA)
  • National Association of Healthcare Access Management (NAHAM)
  • International Council of Nurses
  • National Association of Social Workers
  • Association for Supply Chain Management (APICS)
  • Society of Women Engineers

Certifications

  • Advanced Coding Specialist (ACS) - framework
  • ServSafe
  • Certified Patient Account Manager (CPAM) – initiative
  • Project Management Professional (PMP)
  • Certified Medical Reimbursement Specialist (CMRS) - AMBA
  • Medical Billing and Coding Certification - metric
  • Registered Health Information Technician (RHIT) - AHIMA
  • Certified Revenue Cycle Representative (CRCR) - HFMA
  • Certified Public Accountant (CPA)
  • Microsoft Certified Systems Engineer (MCSE)

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