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Skills

  • First-pass resolution improvements
  • Healthcare claim resolution technologies
  • Immunizations
  • Cross-functional team leadership
  • Medicare/Medicaid reimbursement expertise
  • Automation of denial alerts
  • Claim recovery strategies
  • Compliance with payer guidelines
  • Multidisciplinary team collaboration
  • Healthcare claim analysis

Work Experiences

  • Cleaned up the pharmacy area by removing trash and straightening the counters.
  • Redesigned patient access and back-office workflow processes, resulting in a system-wide staffing cost reduction of 16%.
  • Adjudicated claims effectively.
  • Automated denial alert systems.
  • Collaborated with cross-functional teams including billing, compliance, and payer relations to resolve 11 high-value claims, recovering $10 in reimbursements.
  • Achieved a 23% reduction in provider underpayments.
  • Communicated with patients while maintaining the confidentiality of their medical information.
  • Addressed recurring errors.
  • Planned surgeries, handled pre-certifications, and double-checked insurance coverage.
  • Collaborated with the IT department.

Summaries

  • Analytical Denials Reporting Manager with an eye for identifying emerging denial patterns and implementing scalable solutions, leading to a 22% reduction in claim disputes.
  • Denials Reporting Manager with 5 years of successful data analysis and strategic planning experience.
  • Entry-level Pharmacy Manager with exceptional risk assessment and vendor management knowledge.
  • Staff development that results in high-performing teams has been recognized.
  • Healthcare administrator with a track record of providing high-quality healthcare services to patients.
  • Excellent planning and program management skills. Highly organized and hardworking.
  • Achieved team performance improvements of 75%.
  • Develop and lead an office staff that is productive and efficient.
  • Exceptional communicator and proven problem solver.
  • Achieved $11 revenue recovery.

Accomplishments

  • Monitored denial metrics and identified root causes contributing to $18 of denied revenues, leading to actionable changes in the billing process.
  • Implemented an end-to-end appeals process overhaul that resulted in a 45% improvement in reversal of claim denials.
  • Facilitated cross-trained collaborations between billing and clinical teams, reducing denial rates associated with coding errors by 43%.
  • Resolved product issue through consumer testing.
  • Oversaw claim reprocessing efforts that reduced average denial appeal resolution time by 14 days and improved cash flow by $9.
  • Standardized denial reason codes across 17 facilities, improving reporting accuracy by 80% and reducing coding time by 2 hours.
  • Built cross-functional rapport with clinical directors, resulting in real-time claim edits that decreased same-day corrections by 67%.
  • Documented and resolved standard which led to initiative.
  • Presented monthly KPI reports on denial classifications and trends to senior leadership and stakeholders, leading to strategic policy adjustments.
  • Reduced internal denial rework time by 74% by implementing new appeal templates and procedures based on frequent denial reasons.

Affiliations

  • Project Management Institute
  • American Association of Healthcare Administrative Management (AAHAM) – Revenue Cycle Forum, 2023
  • Lions Club
  • Health Finance Institute – Attended Training on Revenue Cycle Solutions, 2015
  • National Association of Healthcare Access Management (NAHAM) – Member, 2022
  • Institute of Healthcare Improvement (IHI) – Participant in Revenue Cycle Workshops, 2024
  • American Society of Healthcare Risk Management (ASHRM) – Certified in Healthcare Risk, 2024
  • Council for Affordable Quality Healthcare (CAQH) – Participant & Collaborator, 2019
  • Epic Users Group Conference – Attendance and Collaboration in Tableau, 2024
  • American Medical Billing Association (AMBA) – Denial Management Certified, 2018

Certifications

  • Certified Healthcare Reimbursement Specialist (CHRS)
  • Root Cause Analysis and Corrective Action (RCA-CA) Certification
  • Certified Revenue Cycle Professional (CRCP)
  • Apple Certified Associate (ACA)
  • Certified Healthcare Financial Professional (CHFP) - HFMA
  • Certified Denials and Appeals Specialist (CDAS)
  • AAPC Certified Outpatient Coder (COC)
  • Salesforce
  • Certified Professional Coder (CPC)
  • Advanced Nursing Informatics Training Certification (ANITC)

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