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Skills

  • Data entry
  • Business operations
  • Team management
  • Time management and prioritization
  • Coordination with insurance payers
  • Understanding of medical terms
  • Organization
  • MS Office
  • Customer service
  • HIPAA compliance

Work Experiences

  • Communicated with billing, coding, and insurance departments.
  • Achieved a 16% increase in resolution rate.
  • Addressed coding-related denials.
  • Analyzed denial trends and root causes.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Audited challenging accounts, discovering opportunities for additional reimbursement and successfully appealing $14 worth of claims.
  • Audited challenging accounts.
  • Conducted proactive follow-ups.
  • Had an excellent attendance record and was always on time for work.
  • Analyzed denials by payer, department, and service type.

Summaries

  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.
  • Achieved a 74% increase in the success of appeals.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Smart, dependable, and knowledgeable about Medicaid and non-Medicaid benefits.
  • Adept at solving claim-related issues.
  • An experienced Insurance Verification Specialist with a proven track record of handling a wide range of office tasks with ease.
  • Hardworking Denial Specialist with 6 years of telecommuting experience meeting customer needs.
  • Costs were consistently reduced while profits were increased.
  • Adept at utilizing Salesforce systems.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to standard regulations and framework department guidelines.

Accomplishments

  • Implemented process enhancements in the account resolution department, which decreased claim denial resolution times by 74% year-over-year.
  • Collaborated closely with providers and billing departments to improve documentation practices and reduce coding errors, lowering denial incidence by 25%.
  • Maintained comprehensive, up-to-date knowledge of payer guidelines that contributed to reducing inappropriate denials and increasing overall revenue throughput.
  • Partnered with billing staff to resolve discrepancies and resubmit claims, increasing resubmission success rate by 39%.
  • Reduced A/R aging by 21% by strategically prioritizing high-value denied claims and fostering strong payer relationships.
  • Assessed claim denial trends to proactively prevent recurring issues, cutting repetitive denials by 61% over three years.
  • Optimized denial recovery strategies by leveraging analytics and cross-functional insights, leading to a 75% reduction in denied claim volume.
  • Generated detailed claims denial reports that informed executive-level decisions, driving long-term improvements in the revenue cycle management process.
  • Led a process improvement project for appeals, cutting appeal times by 8 days and achieving a 60% uplift in successful claim recoveries.
  • Authored a comprehensive denial resolution handbook that reduced error rates and improved overall team accuracy by 69%.

Affiliations

  • Association for Integrity in Health Care Documentation
  • Society of Women Engineers
  • National Council for Prescription Drug Programs (NCPDP)
  • Institute of Finance and Management (IOFM)
  • American Academy of Professional Coders (AAPC)
  • American Marketing Association
  • Continuing Education in Healthcare Denials and Coding through Brightline
  • Freemason
  • Denials Management Certification from initiative
  • Toastmasters

Certifications

  • Google Certified Professional Cloud Architect
  • Certified Healthcare Reimbursement Specialist (CHRS)
  • Salesforce
  • Ambulatory Care Coding Certification (CANPC) - AAPC
  • Health Information Management (HIM) Certification
  • CompTIA Network+
  • Certified Revenue Cycle Specialist (CRCS) - AAHAM
  • Project Management Professional (PMP)
  • Certified Revenue Integrity Analyst (CRIA)
  • Fellow of the Healthcare Financial Management Association (FHFMA) - HFMA

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