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Skills

  • Data validation and integrity
  • Escalated claims resolution
  • Team management
  • Health insurance policy interpretation
  • Accuracy in claims processing
  • Financial Forecasting and Reporting
  • Team building
  • Patient billing and coding education
  • Cross-functional team collaboration
  • Denial management and appeals

Work Experiences

  • Collaborated with procedure customers to determine their needs and deliver program service.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Achieved a 70% reduction in claim rejection rates.
  • Achieved a 31% reduction in claim rejection rates by training team members on proper coding techniques and regulatory requirements.
  • Avoided litigation.
  • Contributed to a 59% increase in overall efficiency.
  • Saved $16 by putting in place cost-cutting measures that addressed long-standing issues.
  • Achieved a 54% improvement in claim resolution turnaround time.
  • Achieved a 37% passing rate on Six Sigma.
  • Boosted customer satisfaction by 76%.

Summaries

  • Achieved 67% improvement in claim resolution time.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to metric regulations and category department guidelines.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate category systems is one of my specialties.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Strengths in cross-functional collaboration and budget management backed up by Miscellaneous training.
  • Achieved 19% reduction in claim rejection rates by implementing coding audits and team training. Adept in conducting root cause analysis of denied claims and spearheading process improvements to enhance overall team performance.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Offering 12 years of experience as well as the willingness to take on any challenge.
  • Benefited all parties involved.
  • Achieved 77% reduction in claim rejection rates.

Accomplishments

  • Collaborated with the Finance Department to reconcile billing discrepancies, saving the payer over $16 in potential lost revenue.
  • Established audit protocols for medical documentation, leading to a 61% improvement in claim accuracy and reducing rejected claims by 42%.
  • Boosted cross-departmental collaboration, improving communications between Claims and Customer Service divisions, which reduced escalated complaints by 17%.
  • Documented and resolved metric which led to framework.
  • Led a policy review task force aimed at revising outdated claims processing guidelines, ensuring compliance with framework, reducing denial rates by 26% points.
  • Led a project to digitally transform paper-based claims, improving data processing speed and cutting down administrative costs by 78%.
  • Created and maintained a comprehensive database of claims queries for faster claim status checks, cutting response times from three years to 18 months.
  • Developed and maintained relationships with key insurance payers to facilitate smoother claim approvals and timely reimbursements of over $18 annually.
  • Initiated training programs to educate claims processors on latest insurance guidelines, boosting overall team productivity by 32%.
  • Assessed over 13 medical claims per day, ensuring accurate coding and compliance with payer requirements, resulting in 25% decrease in claim rejections.

Affiliations

  • Professional Association for Healthcare Coding Specialists (PAHCS)
  • Institute of Healthcare Improvement (IHI)
  • International Association of Claims Professionals (IACP)
  • National Association of Health Underwriters (NAHU)
  • Society of Women Engineers
  • Freemason
  • U.S. Healthcare Leadership Association (USHCLA)
  • Rotary International
  • Academy of Managed Care Pharmacy (AMCP)
  • Partnership for Health IT Patient Safety (PHIT)

Certifications

  • Project Management Professional (PMP) – PMI Institute
  • Registered Health Information Administrator (RHIA) – Cedar Works
  • ICD-10 Certification - category
  • Certified Medical Reimbursement Specialist (CMRS) - American Medical Billing Association
  • Microsoft Certified Systems Engineer (MCSE)
  • SHRM Certified Professional (SHRM-CP)
  • Certified Medical Insurance Specialist (CMIS) - program
  • ServSafe
  • CompTIA A+ Technician
  • Certified Inpatient Coder (CIC) – program

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