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Skills

  • Problem resolution
  • Attention to detail in claim audits
  • Team management
  • Performance metrics analysis
  • Insurance claim software experience (Jira)
  • Supervision
  • E-filing protocols
  • Communications
  • Appeal resolution
  • Customer service

Work Experiences

  • Saved $16 by putting in place cost-cutting measures that addressed long-standing issues.
  • Achieved a 27% reduction in duplicate claims.
  • Analyzed insurance claim patterns.
  • Kept patient finances, records, and health statuses confidential.
  • Addressed complex claim adjustments.
  • Assessed over 16 claims monthly.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Achieved 33% error reduction.
  • Analyzed claims to resolve patient balances.
  • Achieved a 15% resolution rate.

Summaries

  • Agile Dental Claims Processor with demonstrated expertise in complex claim adjudication, consistently reducing rejections by 56% through effective communication and thorough documentation.
  • Dental Claims Processor with 2 years of experience, dedicated to providing personalized, courteous service.
  • Achieved annual payment recoveries totaling over $11.
  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Offering 15 years of experience as well as the willingness to take on any challenge.
  • Accomplished in dental claim audits, identifying discrepancies on 28% of claims, and ensuring timely correction for optimized reimbursement and accuracy in billing procedures.
  • Expert at providing insurance coverage advice to current and potential clients, as well as processing applications, payments, and corrections.
  • Achieved this for 6 consecutive years.
  • Hardworking Dental Claims Processor with 9 years of telecommuting experience meeting customer needs.

Accomplishments

  • Resolved product issue through consumer testing.
  • Documented and resolved standard which led to system.
  • Achieved a 63% reduction in claim adjudication time by automating routine tasks through Power BI.
  • Collaborated with insurance providers to correct claim payment discrepancies, resulting in a 24% improvement in revenue capture.
  • Utilized comprehensive knowledge of CPT and CDT codes to ensure claim information met insurance payer standards, reducing denials by 47%.
  • Assisted dental providers in the accurate submission of claims, eliminating errors and increasing first-pass acceptance by 16%.
  • Introduced real-time reporting in Salesforce that improved transparency and reduced unresolved claims by 75%.
  • Negotiated denial resolution on claims valued over $14, recovering funds that would have otherwise been lost.
  • Consistently exceeded performance benchmarks, processing 6 claims weekly while maintaining a 42% accuracy rate.
  • Reduced claim error processing by 58% through enhanced training on dental coding and documentation requirements.

Affiliations

  • Office of Inspector General (OIG) Compliance Network for Dental
  • Society of Women Engineers
  • Association for Supply Chain Management (APICS)
  • Lions Club
  • American Dental Coders Association (ADCA)
  • American Association of Professional Coders (AAPC)
  • Board of Dental Examiners for Portland
  • Freemason
  • American Dental Association (ADA)
  • Medical Group Management Association (MGMA)

Certifications

  • Certified Healthcare Administrative Professional (cHAP) - Vantage
  • Advanced CDT Coding Certification - 2024
  • CompTIA Security+
  • Certified Professional in Healthcare Quality (CPHQ) - Harbor & Co.
  • Certified Business Analysis Professional (CBAP)
  • SHRM Certified Professional (SHRM-CP)
  • Microsoft Certified Systems Engineer (MCSE)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Dental Claims Specialist (CDCS) - 2022
  • First Aid/CPR Certified

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