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Skills

  • Healthcare analytics and reporting tools
  • Occupancy strategies
  • Denial trend reporting
  • Loss prevention management
  • Drug utilization review
  • Healthcare claim analysis
  • First-pass resolution improvements
  • Appeals process optimization
  • Patient education and counseling
  • Project oversight

Work Experiences

  • Increased patient satisfaction by 16% within the past year.
  • Collaborated with cross-functional teams including billing, compliance, and payer relations to resolve 11 high-value claims, recovering $10 in reimbursements.
  • Advocated for changes in payer agreements to address recurring denial causes, reducing the overall volume of denied claims by 80% within the past year.
  • Collaborated with legal and compliance teams to adjudicate claims effectively, resolving complex denials that had been outstanding for over 4 months.
  • Acted as the liaison with payers.
  • Created and implemented a leadership development, coaching, and team management model that resulted in employees being promoted to higher levels of responsibility.
  • Achieved results within several months.
  • Cleaned up the pharmacy area by removing trash and straightening the counters.
  • Achieved a 82% reduction in denial rates.
  • Provided information on various immunizations to patients and patrons, including flu, DTaP, and HPV vaccines.

Summaries

  • Achieved a 82% increase in first-pass resolution rates.
  • Denials Reporting Manager with 5 years of successful data analysis and strategic planning experience.
  • Dedicated Pharmacy Manager with experience with regulatory requirements and a passion for assisting people from all walks of life.
  • Astute professional with extensive experience in pharmacy operations and performance metrics.
  • Achieved 52% improvement in revenue recovery.
  • Accomplished healthcare professional.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Strong organizational skills, as well as a thorough knowledge of data collection and performance metrics.
  • Achieved $13 annual recovery in denied claims.
  • Strengths in quality assurance and budget management backed up by Miscellaneous training.

Accomplishments

  • Developed a denials management scorecard used across all locations, measuring KPI trends and leading to a 37% reduction in recurrent denials.
  • Oversaw claim reprocessing efforts that reduced average denial appeal resolution time by 14 days and improved cash flow by $9.
  • Orchestrated team training programs to enhance claim adjudication accuracy, leading to a 23% increase in claim acceptance rates.
  • Reduced internal denial rework time by 74% by implementing new appeal templates and procedures based on frequent denial reasons.
  • Developed a comprehensive training module focused on denials prevention, which led to a substantial reduction in staffing billing mistakes.
  • Created dashboards within Jira to actively monitor key denial metrics in real-time, enabling proactive resolution efforts.
  • Implemented an end-to-end appeals process overhaul that resulted in a 45% improvement in reversal of claim denials.
  • Monitored denial metrics and identified root causes contributing to $18 of denied revenues, leading to actionable changes in the billing process.
  • Presented monthly KPI reports on denial classifications and trends to senior leadership and stakeholders, leading to strategic policy adjustments.
  • Drove efficiency gains in denial handling workflows, resulting in a 53% decrease in average days to resolve denied claims.

Affiliations

  • Healthcare Financial Management Association (HFMA) – Certified Revenue Cycle Representative, 2016
  • International Association of Administrative Professionals
  • Society of Human Resource Management
  • Association for Supply Chain Management (APICS)
  • Health Level Seven International (HL7) – Contributor to Data Standardization Project, 2020
  • National Association of Social Workers
  • American Marketing Association
  • Healthcare Information and Management Systems Society (HIMSS) – Speaker and Attendee, 2015
  • Project Management Institute
  • American Health Information Management Association (AHIMA) – Member, 2018

Certifications

  • Certified Specialist Health Information Management (CSHIM)
  • SHRM Certified Professional (SHRM-CP)
  • Salesforce
  • CompTIA A+ Technician
  • Compliance Certification Board (CCB) Certified Professional in Healthcare Quality (CPHQ)
  • Certified Denials and Appeals Specialist (CDAS)
  • American Association of Healthcare Administrative Management (AAHAM) Certified Revenue Integrity Professional (CRIP)
  • First Aid/CPR Certified
  • Certified Professional Coder (CPC)
  • Certified Healthcare Reimbursement Specialist (CHRS)

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