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Skills

  • Denial management and recovery
  • Cash handling expertise
  • Contract analysis and optimization
  • Claims processing streamlining
  • Healthcare compliance and regulations
  • Continuous process improvement
  • Regulatory compliance
  • Business Development
  • Team building
  • EDI transactions and standards

Work Experiences

  • Achieved a 70% reduction in claim underpayments after restructuring workflows and incorporating payer feedback in 2019.
  • Used effective networking to identify and capitalize on community business opportunities.
  • Achieved a 49% reduction in claim underpayments.
  • Achieved a 19% reduction in claim rejection rates.
  • Achieved results in Seattle over 2 months.
  • Advocated for and secured $67,000 in increased reimbursement through legislative engagement and payer negotiations on relevant billing codes.
  • Advocated for increased reimbursement.
  • Reviewed and edited loan agreements to improve efficiency and accuracy.
  • Evaluated employee performance and devised strategies for improvement.
  • Used positive motivational techniques to engage employees in business processes.

Summaries

  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the initiative business.
  • Achieved 84% increases in per-case reimbursement.
  • To meet and exceed business financial goals, successfully optimizes frameworks and cultivates cohesive teams.
  • Collaborated with clinical, legal, and financial stakeholders.
  • Director of Reimbursement with 5 years of successful project management and stakeholder engagement experience.
  • Accomplished Director with a proven ability to restructure ineffective reimbursement workflows, resulting in up to a 22% increase in claims accuracy and adherence.
  • Achieved increases of 26% in reimbursement rates.
  • Adept in leveraging CMS and payer policy knowledge.
  • Strengths in client relations and strategic planning backed up by Miscellaneous training.
  • Accomplished Director of Reimbursement with consistent success in negotiating insurance contracts that improve reimbursement terms and reduce payment delays by 26%.

Accomplishments

  • Achieved metric, which bolstered compliance with payer-specific requirements and improved overall reimbursement rates by 72%.
  • Developed strategies to optimize Medicare and Medicaid reimbursements, reducing denied claims by 7 annually.
  • Resolved product issue through consumer testing.
  • Revamped claims submission workflows, resulting in 55% reduction of rework and a 80% increase in first-pass resolution rate.
  • Chaired cross-functional taskforce that resolved delays in reimbursement, reducing average claim resolution time by 18%.
  • Guided the implementation of a patient financial counseling program, increasing revenue from self-pay patients by 37%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Led a reimbursement audit preparation that resulted in a 20% reduction of compliance-related financial penalties.
  • Led a cross-functional team in reducing reimbursement claim denials by 65%, enhancing overall operational efficiency.
  • Negotiated contracts with procedure to implement bundled reimbursement strategies, increasing net revenue by $46,000.

Affiliations

  • Association of Information Technology Professionals
  • National Association of Healthcare Access Management (NAHAM) active participant
  • Financial Management in Healthcare Forum speaker and attendee
  • International Association of Administrative Professionals
  • Toastmasters
  • Active contributor to Tableau Reimbursement Automation Group
  • Medicare/Medicaid Advisory Panel participant for reimbursement policy improvements
  • Member of the National Association of Healthcare Revenue Consultants (NAHRC)
  • International Council of Nurses
  • American Society of Safety Professionals

Certifications

  • Lean Six Sigma Green Belt Certification for Healthcare - Beacon Labs, 2022
  • Certified Public Accountant (CPA)
  • Certified Healthcare Business Consultant (CHBC) - Vantage, 2023
  • Microsoft Certified Systems Engineer (MCSE)
  • Google Certified Professional Cloud Architect
  • Certified Revenue Cycle Executive (CRCE) - 2023 (Cedar Works)
  • Certified Government Healthcare Administrator (CGHA) - Harbor & Co.
  • Healthcare Financial Management Association (HFMA) Certified Healthcare Financial Professional (CHFP) – 2019
  • Certified Public Accountant
  • Apple Certified Associate (ACA)

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