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Skills

  • Documentation abilities
  • Multilingual communication German
  • Insurance claim software experience (Jira)
  • Team collaboration and leadership
  • Performance metrics analysis
  • Advanced Microsoft Excel skills for reporting
  • Confidential handling of patient data
  • Customer service excellence
  • Reporting skills
  • First Aid/CPR

Work Experiences

  • Analyzed insurance claim patterns.
  • Achieved a 37% reduction.
  • Analyzed insurance claim patterns and recommended process improvements, leading to a 53% reduction in duplicate claims.
  • Achieved payment within the first 6 months.
  • Collaborated with operations to resolve 11 complex claim denials, resulting in a 55% increase in successful appeal outcomes.
  • Addressed complex claim adjustments and write-offs, saving $15 annually for the dental group.
  • Collaborated with dental providers and insurance companies to resolve payment discrepancies, recovering $14 in outstanding claim payments.
  • Analyzed claims to resolve patient balances.
  • Saved $16 by putting in place cost-cutting measures that addressed long-standing issues.
  • Achieved zero privacy violations over two years.

Summaries

  • Within Miscellaneous, senior Dental Claims Processor and outstanding performer in data analysis and team leadership.
  • Analytical Dental Claims Processor.
  • Analytical Dental Claims Processor with strong skills in KPI tracking and reporting, contributing to a 29% reduction in total appeals through continuous monitoring and data-driven insights.
  • Dental Claims Processor with 2 years of experience, dedicated to providing personalized, courteous service.
  • Certified Dental Claims Processor.
  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.
  • Achieved savings through detailed research and strategic collaboration.
  • Agile Dental Claims Processor.
  • Experienced framework Insurance Specialist with a track record of managing large caseloads in high-pressure situations.
  • Collaborated with marketing to streamline claims processing.

Accomplishments

  • Recovered approximately $5 from previously denied claims through thorough investigation and dispute resolution with insurance carriers.
  • Achieved a 63% reduction in claim adjudication time by automating routine tasks through Power BI.
  • Minimized delays in claim processing by initiating a new electronic submission protocol, improving turnaround times by 17%.
  • Resolved high-priority claims, with expedited processing for complex cases valued at $15 or greater.
  • Documented and resolved standard which led to system.
  • Collaborated with insurance providers to correct claim payment discrepancies, resulting in a 24% improvement in revenue capture.
  • Reviewed and updated dental fee schedules in collaboration with insurance carriers, ensuring pricing accuracy across 16 dental offices.
  • Handled dispute resolutions between patients and payers, closing cases in under 2 hours and ensuring patient satisfaction.
  • Monitored and analyzed trends in claim denials and resubmissions to identify root causes, reducing repeat denials by 22%.
  • Created detailed monthly reports that tracked claim processing timelines, enabling data-driven improvements to the claims workflow.

Affiliations

  • Professional Association of Health Care Office Management (PAHCOM)
  • Society of Women Engineers
  • Jaycees
  • Society of Human Resource Management
  • American Society of Safety Professionals
  • Society of Insurance Research (SIR)
  • National Healthcareer Association (NHA)
  • Lions Club
  • International Claim Association (ICA)
  • State Raleigh Dental Health and Claim Processing Board

Certifications

  • Certified Insurance Claims Specialist (CICS) - 2019
  • Cisco Certified Internetwork Expert (CCIE)
  • Google Certified Professional Cloud Architect
  • Dental Billing & Coding Specialist (DBC) - Cedar Works
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Business Analysis Professional (CBAP)
  • Certified HIPAA Professional (CHP) - 2021
  • Certified Healthcare Claim Professional (CHCP) - Harbor & Co.
  • Certified in Healthcare Compliance (CHC) Brightline
  • Medical Office Administrative Procedures Certificate - 2020

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