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Skills

  • Business operations
  • Time management and prioritization
  • Denial tracking system implementation
  • First Aid/CPR
  • Relationship development
  • Prior authorization processing
  • Regulatory compliance
  • Insurance claims follow-up
  • Effective communication with payers and patients
  • High-volume claims resolution

Work Experiences

  • Consistently recovered over $7 annually.
  • Collaborated with the coding team.
  • Solved process issues, improved operations, and provided excellent customer service.
  • Collaborated with cross-functional teams, actively communicating with billing, coding, and insurance departments to ensure timely resolution of denials and disputes.
  • Accomplished this within several months.
  • Authored an internal guide for best practices in denial resolution.
  • Achieved a 64% increase in appeals won.
  • Analyzed denials by payer, department, and service type.
  • Collaborated with the coding team to address coding-related denials, leading to a 26% reduction in inappropriate denials linked to coding errors.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.

Summaries

  • Collaborated with billing and coding teams.
  • Denial Specialist with 4 years of successful performance reporting and team leadership experience.
  • Adept at utilizing Salesforce systems.
  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved department-wide increase in claim resolution rates of 24%.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to standard regulations and framework department guidelines.
  • Achieved 74% faster turnaround times.
  • Denial Specialist with 10 years of experience, dedicated to providing personalized, courteous service.
  • Expert in all aspects of the insurance sales cycle, including prospecting and follow-up.

Accomplishments

  • Consistently collaborated with payers and internal stakeholders to resolve denied claims, reducing turnaround times by 3 days and improving total claim approvals.
  • Developed an SOP on handling payer appeals that helped reduce denied service claims turnarounds by 18 days.
  • Gathered and analyzed data on denial trends to refine denial prevention strategies, reducing overall denials by 75% across one year.
  • Collaborated with team of 11 in the development of program.
  • Presented key insights and recommendations at departmental meetings based on denial metrics, driving optimized revenue performance and team alignment.
  • Managed a portfolio of 4 denied healthcare claims, successfully recovering 22% of lost revenue, amounting to over $9 annually.
  • Successfully appealed 11 denied claims, resulting in a revenue recovery increase of $15 within one year.
  • Implemented a real-time denial tracking system that increased claim follow-up efficiency, reducing rework by 39%, and decreasing resolution time by 2 days.
  • Maintained comprehensive, up-to-date knowledge of payer guidelines that contributed to reducing inappropriate denials and increasing overall revenue throughput.
  • Monitored denial reasons and trends, recommending coding changes or payer negotiations that improved claim acceptance rate by 68%.

Affiliations

  • Revenue Cycle Academy
  • Society of Women Engineers
  • National Healthcareer Association (NHA)
  • Society of Human Resource Management
  • American Case Management Association (ACMA)
  • Health Care Compliance Association (HCCA)
  • Association for Integrity in Health Care Documentation
  • Continuing Education in Healthcare Denials and Coding through Brightline
  • American College of Healthcare Executives (ACHE)
  • American Society of Safety Professionals

Certifications

  • Revenue Cycle and Denial Management Specialist (RCDMS) Certification
  • Certified Public Accountant
  • Ambulatory Care Coding Certification (CANPC) - AAPC
  • Certified Professional Coder (CPC) - AAPC
  • Certified Healthcare Reimbursement Specialist (CHRS)
  • Certified Revenue Integrity Professional (CRIP) – NAHRI
  • Certified Revenue Integrity Analyst (CRIA)
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Business Analysis Professional (CBAP)
  • Certified Healthcare Access Manager (CHAM) category

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