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Skills

  • Accreditation coordination
  • Insurance denial management
  • Relationship building and retention
  • Immunizations
  • Cross-functional team leadership
  • Healthy meal preparation
  • Case mix index management
  • Project oversight
  • Electronic Health Record (EHR) integration
  • Discharge planning efficiency

Work Experiences

  • Contributed to an 9 improvement in operating margin.
  • Brainstormed and implemented hard stops.
  • Collaborated with senior leadership to implement a value-based care approach, which contributed to an 12 improvement in operating margin.
  • Created and updated HIPAA, benefits administration, and general liability policies and procedures while adhering to statutory, regulatory, and local, state, and federal guidelines.
  • Achieved favorable reimbursement structures totaling 17.
  • Achieved a 38% success rate in overturning initial decisions.
  • Assisted in creating budget forecasts.
  • Appointed as the regional leader for utilization integrity, implementing regional guidelines that reduced claim denials across 15 facilities.
  • Accomplished results within 2024.
  • Achieved zero audit issues in 2022.

Summaries

  • Achieved improvements in overall department efficiency by 58%.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Analytical leader dedicated to improving healthcare delivery.
  • Achieved measurable cost reductions.
  • Accomplished in healthcare utilization review.
  • Develop and lead an office staff that is productive and efficient.
  • Achieved audit success with zero issues for 11 years.
  • Hope to help Summit Group achieve even greater success by leveraging my personal skill set and proactive demeanor.
  • Excellent planning and program management skills. Highly organized and hardworking.
  • Oversee human resources, budgeting, supply management, and patient services with success.

Accomplishments

  • Resolved product issue through consumer testing.
  • Successfully reduced claim rejection rates for high-cost specialty drugs by 79% by implementing a regimented pre-authorization system.
  • Optimized relationships with third-party payers, resulting in a 51% decrease in claim denials through collaborative resolution efforts.
  • Designed a workflow to prioritize complex cases, reducing third-party review delays by 84% hours, improving patient access to timely care.
  • Reduced average length of stay by 28% days through improved patient flow and clinical documentation training for physicians.
  • Reduced healthcare-associated costs by 16 through the successful dispute and reversal of incorrectly denied claims from state Medicaid payers.
  • Devised a multi-channel communication strategy between UR nurses and specialty providers, improving issue resolution by 72% in 2023.
  • Facilitated cross-functional utilization review committees that led to a 75% reduction in discharge delays across 4 departments.
  • Utilized data analytics to improve accuracy of inpatient vs outpatient coding, reducing unnecessary observation days by 18 annually.
  • Standardized post-discharge follow-up protocols, significantly improving patient outcomes and driving a 44% reduction in patient escalation scenarios.

Affiliations

  • Case Management Society of America (CMSA)
  • Association for Computing Machinery
  • Rotary International
  • Managed Care Risk Association (MCRA)
  • Toastmasters
  • Accreditation Commission for Health Care (ACHC)
  • American Association for Physician Leadership
  • URAC (Utilization Review Accreditation Commission)
  • Association for Clinical and Translational Science (ACTS)
  • Society for Healthcare Strategy and Market Development (SHSMD)

Certifications

  • CompTIA Network+
  • Fellow of the American College of Healthcare Executives (FACHE) – 2017
  • Certified Executive in Healthcare Information Management (CEHIM) - 2020
  • CompTIA A+ Technician
  • Certified Utilization Review Specialist (C-URS) - 2016
  • Certified in Healthcare Compliance (CHC) 2016
  • Cisco Certified Network Associate (CCNA)
  • Certified Public Accountant (CPA)
  • First Aid/CPR Certified
  • Accredited Case Manager (ACM), 2023

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