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Skills

  • Insurance Verification
  • Appeal resolution
  • Claim processing
  • System equipment
  • Effective oral and written communication skills
  • Fraud prevention and detection
  • Staff training and development
  • Performance metrics analysis
  • Customer dispute resolution
  • Budgets

Work Experiences

  • Achieved a 37% reduction.
  • Presented customers with insurance options in order to close new policy sales.
  • Communicated effectively with dentists to clarify treatment plans necessary for claim approval, resulting in fewer rejections.
  • Addressed account reviews for pending payments by analyzing claims and leveraging relationships to resolve patient balances of $16.
  • Addressed complex claim adjustments and write-offs, saving $15 annually for the dental group.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Adjudicated dental claims in accordance with contract guidelines.
  • Reviewed open requests and redirected workloads to ensure that projects were completed on time.
  • Looked for industry trends on social media and through online sources.
  • Collaborated with customer success to resolve complex claim denials.

Summaries

  • Clear understanding of data analysis and team leadership as well as stakeholder engagement training.
  • Analytical Dental Claims Processor.
  • Dental Claims Processor with 16 years of successful performance reporting and risk assessment experience.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Within Miscellaneous, senior Dental Claims Processor and outstanding performer in data analysis and team leadership.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved 65% improvement in claim approval turnaround.
  • Dental Claims Processor with 2 years of experience, dedicated to providing personalized, courteous service.
  • As a detail-oriented Dental Claims Processor, I ensure regulatory compliance while reducing claim processing times and error rates by leveraging advanced data entry and auditing techniques.
  • Hardworking Dental Claims Processor with 9 years of telecommuting experience meeting customer needs.

Accomplishments

  • Reviewed and updated dental fee schedules in collaboration with insurance carriers, ensuring pricing accuracy across 16 dental offices.
  • Developed and maintained detailed claims spreadsheets using Microsoft Excel, enhancing visibility and tracking of ongoing claims.
  • Successfully processed an average of 15 dental claims per day, ensuring timely reimbursements for all parties involved.
  • Resolved high-priority claims, with expedited processing for complex cases valued at $15 or greater.
  • Effectively reduced claim rejection rates in 2019 by 49% through detailed policy reviews and improved claim documentation.
  • Documented and resolved standard which led to system.
  • Used Microsoft Excel to provide real-time claims data to stakeholders, enhancing overall tracking and reporting capabilities.
  • Monitored and analyzed trends in claim denials and resubmissions to identify root causes, reducing repeat denials by 22%.
  • Collaborated with insurance providers to correct claim payment discrepancies, resulting in a 24% improvement in revenue capture.
  • Consistently exceeded performance benchmarks, processing 6 claims weekly while maintaining a 42% accuracy rate.

Affiliations

  • Professional Association of Health Care Office Management (PAHCOM)
  • Association for Computing Machinery
  • American Marketing Association
  • Lions Club
  • American Institute of Dental Business Management
  • National Healthcareer Association (NHA)
  • Healthcare Financial Management Association (HFMA)
  • National Association of Insurance Commissioners (NAIC)
  • International Council of Nurses
  • American Medical Informatics Association

Certifications

  • SHRM Certified Professional (SHRM-CP)
  • Medical Office Administrative Procedures Certificate - 2020
  • Certified Dental Claims Specialist (CDCS) - 2022
  • CompTIA A+ Technician
  • Claims and Risk Management Certificate - Meridian
  • Dental Billing & Coding Specialist (DBC) - Cedar Works
  • Google Certified Professional Cloud Architect
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Medical Administrative Assistant (CMAA), 2019
  • Certified Revenue Cycle Specialist (CRCS) Harbor & Co.

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