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Skills

  • Relationship development
  • Conflict resolution and mediation skills
  • Team building
  • Planning and coordination
  • Insurance billing
  • Multi-tasking in deadline-driven environments
  • Onboarding and mentorship of new staff
  • Financial audits and investigations
  • Error reduction initiatives
  • Collaboration with legal and policy teams

Work Experiences

  • Determined what rate locks, disclosures, overage and underage waivers, and fee waivers were appropriate.
  • Kept my framework knowledge up to date by doing project management and performance reporting.
  • Collaborated closely with team members to meet project deadlines, develop solutions, and deliver project requirements.
  • Developed a reputation for punctuality and hard work.
  • Listened carefully to customer complaints and took appropriate action to ensure a quick and effective resolution.
  • Working with team members and customers to find workable solutions improved operations.
  • Aligned financial eligibility criteria with evolving regulations.
  • Discovered valuable solutions for credit-challenged customers.
  • Collaborated with operational managers to align financial eligibility criteria with evolving regulations, resulting in Excellence Award for process improvement in 2024.
  • Addressed claims worth over $10.

Summaries

  • Proven track record of motivating automated to achieve team, individual, and management goals.
  • Accomplished Financial Eligibility Team Lead focused on aligning policies with legal requirements, recognized with Excellence Award for improving internal processes and increasing case accuracy by 85% in 2021.
  • A valuable employee who follows all data privacy laws and regulations.
  • Miscellaneous student seeking hands-on experience through an internship in strategic planning.
  • Exceptional at building client relationships and adhering to credit policies.
  • Achieved 50% improvements in dispute resolution cases.
  • Achieved a 49% resolution success rate.
  • Process, category, and standard are all available.
  • Achieved a 61% decrease in processing errors.
  • Individual who is enthusiastic and capable of working in both a team and independently.

Accomplishments

  • Identified gaps in eligibility procedures leading to a 51% reduction in inaccuracies and improved audit outcomes.
  • Directed an error reduction initiative for eligibility coding, lowering error incidence to less than 82% per submitted case.
  • Designed and managed an incentive program for eligibility officers, leading to a 61% improvement in team KPI performance.
  • Led the onboarding of new financial eligibility team members, achieving full proficiency of the team within two years ahead of schedule.
  • Guided a successful nationwide implementation of new eligibility procedures, reducing overall turnaround time by initiative and increasing accuracy rates to 64%
  • Led a high-performance team that processed over 7 eligibility cases per month, consistently maintaining a 85% error-free rate over two years.
  • Successfully restructured the eligibility team during organizational changes, improving efficiency by 49% while maintaining targeted SLAs (Service Level Agreements).
  • Successfully created training curriculums tailored to improving eligibility staff proficiency, leading to a 40% increase in on-the-job productivity.
  • Developed procedures to enhance client-centric approaches, achieving consistently high client satisfaction by resolving 68% of cases within 8 days.
  • Fostered a collaborative work environment among eligibility officers, resulting in a 78% improvement in team alignment and cross-team decisions.

Affiliations

  • Active involvement in state-level Medicaid advisory boards, contributing insights for system reforms related to financial eligibility.
  • Contributed to the planning committee for a conference on financial eligibility and compliance hosted by the Association of Healthcare Financial Services Administrators.
  • Member of the Risk Management Association (RMA), utilizing group discussions to strengthen skills in identifying and mitigating financial risks.
  • Active member of the American Financial Services Association (AFSA), regularly attending workshops on conflict resolution in financial service environments.
  • Participated in the AICPA (American Institute of CPAs) Financial Management Conference, enhancing knowledge of compliance auditing practices in financial eligibility.
  • Keynote speaker at the National Managed Care Conference sharing best practices for improving multi-location team coordination in financial departments.
  • Completed a six-month mentorship program on eligibility appeals processing through the National Association of Health Plans (NAHP).
  • Served as a speaker at the annual HFMA conference in 2020, presenting on strategies to improve financial eligibility accuracy.
  • Member of Women in Healthcare and Finance Leadership, attending bi-monthly seminars to discuss appeals reduction strategies and risk mitigation in financial sectors.
  • Member of the Financial Inclusion Alliance, focused on improving access to necessary services by refining eligibility processes for underserved communities.

Certifications

  • Certified Global Sanctions Specialist (CGSS)
  • Licensed Customs Broker Examination
  • Six Sigma Green Belt Certification
  • Project Management Professional (PMP)
  • Anti-Money Laundering (AML) Certification
  • Leadership in Energy and Environmental Design (LEED) Accreditation
  • Certified Treasury Professional (CTP)
  • Association for Project Management (APM)
  • ServSafe
  • SAP Certified Application Associate

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