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Skills

  • Performance Metrics Monitoring
  • Regulatory compliance
  • Organization
  • Procedure equipment
  • AI-Powered Claims Processing Solutions
  • ICD-10 and CPT coding
  • Medical billing and coding
  • Negotiation and persuasion skills
  • Complex dispute resolution
  • Team building

Work Experiences

  • Closely monitored key performance indicators (KPIs) and adjusted daily workflows to ensure ongoing improvement in claim resolution times.
  • Determined liability as outlined in the coverage and assessed documentation from police and healthcare providers to understand the damages incurred.
  • Achieved a 17% competency rate.
  • Adjudicated system claims.
  • Achieved results within several months.
  • Examined claim forms and other records to determine insurance coverage.
  • Collaborated with medical providers, policyholders, and underwriters to resolve complex disputes regarding claim eligibility.
  • Assisted in upgrading the claims management system, cutting down administrative overhead by 20% over 18 months.
  • Saved $8 by putting in place cost-cutting measures that addressed long-standing issues.
  • Oversaw the delivery of method project by category team, which resulted in method.

Summaries

  • Achieved a 42% dispute resolution rate.
  • Accomplished Health Insurance Claims Adjudicator.
  • Conducted comprehensive claims audits.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Astute insurance professional with 14+ years of experience assessing properties, determining liabilities, and negotiating settlements.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.
  • Costs were consistently reduced while profits were increased.
  • Certified expert in medical billing and coding.
  • Adept at utilizing AI-assisted claims processing technology, reducing manual claims workloads by 27%, leading to faster turnarounds and lower error rates.

Accomplishments

  • Collaborated across 18 departments to track and improve KPIs in claims processing performance and customer satisfaction.
  • Received President's Club for maintaining 15% accuracy in claims processed within 2021.
  • Performed root cause analyses on escalated claims cases, reducing repeat issues by 62% year-over-year.
  • Led 18-person team in completing an aggressive claims audit schedule, ensuring 45% regulatory compliance.
  • Assisted with the successful rollout of a new claims adjudication system, reducing errors by 47% post-implementation.
  • Streamlined cross-departmental communication channels for high-priority claims, decreasing response time by one year.
  • Contributed to Employee of the Year-winning customer service project by implementing a priority claims processing system.
  • Worked with providers to resolve claim disputes, achieving a 46% resolution rate on first contact.
  • Collaborated with cross-functional teams to improve claims processing accuracy, achieving a 55% reduction in errors over 18 months.
  • Analyzed and recategorized high-priority claims through root cause analysis, decreasing escalation times by 6 months.

Affiliations

  • Managed Care Risk Assessment Conference metric
  • Accredited Healthcare Fraud Investigator (AHFI) Certification
  • American College of Healthcare Executives (ACHE)
  • International Association of Administrative Professionals
  • National Association of Health Underwriters (NAHU)
  • Association of Information Technology Professionals
  • Association for Supply Chain Management (APICS)
  • Medical Group Management Association (MGMA)
  • Healthcare Financial Management Association (HFMA)
  • National Association of Independent Review Organizations (NAIRO)

Certifications

  • Certified Claims Specialist in Medical Billing by PMI
  • Certified Fraud Examiner (CFE) - by ACFE
  • Google Certified Professional Cloud Architect
  • Certified Professional Coder (CPC) by AAPC
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Medical Reimbursement Specialist (CMRS) by AMBA
  • Accredited Healthcare Fraud Investigator (AHFI) by NHCAA
  • First Aid/CPR Certified
  • Project Management Professional (PMP)
  • Managed Care Professional (MCP) Certification by AMCP

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