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Skills

  • Insurance claims software proficiency
  • Regulatory compliance
  • Compliance with industry regulations
  • Operational improvement
  • Metric equipment
  • Process improvement
  • Codes reviewing
  • Data analysis and reporting
  • Relationship development
  • Collection process streamlining

Work Experiences

  • Had an excellent attendance record and was always on time for work.
  • Achieved Top Performer.
  • Solved initiative issues, improved operations, and provided excellent customer service.
  • Actively followed up with customers.
  • Collaborated with legal and compliance teams on high-risk cases, ensuring ethical handling and adherence to operational policies.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Analyzed payment histories to predict future collection risks, reducing bad debt write-offs by $18.
  • Achieved Outstanding Service Award for maintaining a collection rate of over 63% on exceptionally delinquent accounts.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Collaborated with legal and compliance teams.

Summaries

  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved 37% recovery success.
  • Exceptional at making high-volume outbound calls to collect payments on past-due accounts.
  • Closed cases valued at over $18.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Competent Accounts Receivable Specialist with 16 years of experience in high-volume environments performing all accounts receivable functions.
  • Adjusted strategies to align with current trends.
  • Adept at negotiating payment agreements with insurance providers, achieving 78% success in closing cases within several months, helping businesses recover outstanding balances of $13.
  • Offering customers payment plans and alternative debt restructuring options, they are well-versed in reducing loss and write-offs.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.

Accomplishments

  • Negotiated settlements on difficult cases, recovering $23,000 in unpaid claims and reaching favorable outcomes for both provider and insurer.
  • Audited claims and discovered overpayment by 9, initiating refund process to insurers and reducing future discrepancies.
  • Utilized initiative to identify, track, and escalate claims, ensuring an approval rate of 39%.
  • Recovered 10 in outstanding claims by effectively managing 10 high-risk accounts.
  • Created and executed effective follow-up strategies for denied or underpaid claims, resulting in the recovery of 74% disputed payments.
  • Trained and mentored junior staff on optimal claims collection strategies, resulting in a 64% team improvement in collections.
  • Recovered over $205,000 in denied claims within three years by effectively navigating payer challenges and submitting appeals.
  • Successfully handled 2 to 15 accounts daily, ensuring accuracy in claims management and reducing denials by 41%.
  • Consistently achieved monthly collection target of 12, securing timely payment through professional and consistent follow-up.
  • Reduced disputed claims by 39% through accurate claim submissions and rapid resolution of discrepancies.

Affiliations

  • Certified Professional Biller (CPB) through AAPC, 2015
  • Jaycees
  • Medical Reimbursement Society of America (MRSA), Accredited Specialist
  • International Association of Financial Executives in Healthcare, Senior Member
  • Association for Computing Machinery
  • Insurance Accounting and Systems Association (IASA), Professional Member
  • Freemason
  • Associated Claims Career Network (ACCN), Professional Certification in Claims Handling
  • American Medical Informatics Association
  • Certified Revenue Integrity Professional (CRIP) through NAHRI, 2017

Certifications

  • Project Management Professional (PMP)
  • Cisco Certified Internetwork Expert (CCIE)
  • Accredited in Medical Billing (AMB)
  • Certified Managed Care Professional (CMCP)
  • Certified Compliance Professional in Healthcare (CCPH)
  • Certified Credit and Collections Professional (CCCP)
  • Certified Public Accountant (CPA)
  • ServSafe
  • Certified Professional Coder (CPC)
  • CompTIA Network+

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