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Skills

  • Life insurance
  • Billing and coding knowledge
  • Property insurance
  • First Aid/CPR
  • Team leadership and development
  • Claims reporting systems
  • Client onboarding processes
  • Process improvement
  • Client communication and education
  • Bilingual proficiency in French

Work Experiences

  • Authored standardized internal communications templates, which increased team accuracy in member interactions, leading to a 61% decrease in error rates.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Collaborated with the claims department.
  • Collaborated with underwriting, compliance, and legal teams.
  • Accomplished results within the first 8 months.
  • Achieved zero infractions across 16 client records.
  • Achieved results during peak season.
  • Authored standardized internal communications templates.
  • Conducted proactive outreach.
  • Conducted claims review process training.

Summaries

  • Costs were consistently reduced while profits were increased.
  • Awarded President's Club for team performance in 2024.
  • Consistently improved resolution outcomes for denied claims.
  • Accomplished professional with advanced knowledge in government-sponsored healthcare programs, reducing document processing turnaround time by 41%.
  • Champion of client satisfaction, credited with a 33% increase in post-interaction satisfaction scores following the implementation of a revised client triaging protocol.
  • Dedicated customer service professional with extensive experience in policyholder communication, grievance handling, and follow-up, reducing response times to 17 hours on average.
  • Adept in overseeing onboarding and training of new hires.
  • Exceptional juggler of multiple competing responsibilities at the same time.
  • Champion of client satisfaction.
  • Collaborated with healthcare providers to enhance their understanding of health plan benefits, instrumental in reducing escalation rates by 61% through educational outreach.

Accomplishments

  • Led cross-functional team to implement a streamlined claims resolution process that reduced claim turnaround time by 31%.
  • Exceeded performance benchmarks by 24% through leadership in client communications and managed care oversight.
  • Streamlined verification process for eligibility compliance, increasing team efficiency by 39% during initiative.
  • Assisted in resolving high-priority cases, retaining 43% of vulnerable at-risk members during annual coverage review.
  • Developed strategies that improved departmental response times to insurance inquiries, cutting resolution times by 29% hours.
  • Coordinated with human resources to resolve application discrepancies, improving the accuracy of member eligibility tracking by 19%.
  • Collaborated with 2 healthcare providers to improve patient care coordination, leading to 49% improvement in patient outcomes.
  • Collaborated with IT team to integrate a new health information system, cutting report generation times by 45% for management staff.
  • Monitored and ensured 4 team members adhered to HIPAA and other regulatory compliance requirements, achieving 32% compliance.
  • Documented and resolved process which led to initiative.

Affiliations

  • Project Management Institute
  • Council for Affordable Quality Healthcare (CAQH)
  • Healthcare Financial Management Association (HFMA)
  • National Council for Prescription Drug Programs (NCPDP)
  • Association of Information Technology Professionals
  • American Medical Informatics Association
  • Certified Professional Compliance Officer (CPCO) via AAPC
  • Association for Computing Machinery
  • Association for Supply Chain Management (APICS)
  • International Council of Nurses

Certifications

  • Advanced Customer Service & Call Center Certification
  • Certified Compliance and Ethics Professional (CCEP)
  • National Health Information Management Certification (NHIM) by AHIMA
  • Medical Billing and Coding Certification (by NHA or similar)
  • Bilingual Healthcare/Insurance Services Certification (French)
  • Certified Medical Reimbursement Specialist (CMRS) by AMBA
  • Cisco Certified Internetwork Expert (CCIE)
  • ICD-10 Coding Certification by AAPC
  • Certified Healthcare Access Associate (CHAA)
  • Certified Health Insurance Specialist (AHIP)

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