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Skills

  • Customer service
  • Compliance with HIPAA and other regulations
  • Database management
  • Business operations
  • Bi-weekly payer meeting facilitation
  • Medical recordkeeping
  • Health policy compliance
  • Appeal writing and submission
  • MS Office
  • CCTV

Work Experiences

  • Answered 15 phone calls per three years to assist customers.
  • Achieved a 74% faster turnaround.
  • Management recognized me for providing outstanding customer service.
  • Learned process improvement and cross-functional collaboration to help with office needs.
  • Checked and removed unnecessary details from record copies before handing them over.
  • Collaborated with cross-functional teams to fix data inconsistencies, which resulted in a 75% improvement in first-time claim submissions.
  • Collaborated with payers to resolve 13 high-dollar claims, reducing overall denial rate by 63%.
  • Collaborated with payers to resolve high-dollar claims.
  • Relayed information to the appropriate department, individual, or external location.
  • Achieved a 44% reduction in claim rework.

Summaries

  • Exceptional at juggling multiple goals in order to maximize efficiency and influence positive outcomes.
  • Insurance Follow-up Specialist and team leader with 18 years of experience in procedure settings.
  • Standard and procedure have a proven track record.
  • Adaptable and motivated, with a strong work ethic and the ability to thrive in either a team-based or individually motivated environment.
  • Strong technical skills and experience in data analysis.
  • Stakeholder engagement Committed to identifying and leveraging opportunities for growth, with a proven ability to build effective teams.
  • Bilingual individual with a friendly demeanor and a desire to assist in any way possible.
  • With hands-on experience, eager to learn new skills and advance knowledge.
  • Achieved a 31% increase in monthly revenue.
  • Expert in procedure with a strong aptitude for coordinated and launched.

Accomplishments

  • Implemented streamlined communication channels between billing teams and insurance payers that led to a 82% reduction in claim issues and improved AR turnover rates.
  • Collaborated with leadership to identify KPIs related to claims processing and trained staff, reducing time to resolution by 82% for high-dollar claims.
  • Achieved a 18% improvement in first-time claim submission success rate by coordinating extensively with coding departments to correct procedural codes.
  • Secured payments for over 18 aging claims through rigorous follow-up processes, recovering $17 in unpaid balances over 6 months.
  • Developed and facilitated bi-weekly meetings with 15 major payers to ensure consistent claims status updates, securing a 41% decrease in outstanding claims over 18 months.
  • Increased payer compliance in responding to claims inquiries by establishing a 18 months follow-up schedule and improving recovery rates by 42%.
  • Oversaw a portfolio of complex, high-dollar claims worth $4, reducing overall outstanding balances significantly and closing 4 aged claims.
  • Proactively resolved discrepancies on high-dollar accounts within several months, successfully recovering $12 in lost revenue for the company.
  • Improved the accuracy of claim submissions across 3 departments by introducing updated SOPs and facilitating training sessions, reducing denial rates by 27%.
  • Reduced backlog of pending claims over one year by 16% by prioritizing older cases and implementing follow-up schedules with staff.

Affiliations

  • Certified Professional Coder (CPC) – American Academy of Professional Coders (AAPC) 2024
  • Active Participant, HFMA Revenue Cycle Improvement Boot Camp 2019
  • Graduate or Participant of Healthcare Revenue Cycle Leadership Academy 2021
  • Active Member, Medical Group Insurance Follow-Up Forum 2020 – Present
  • Volunteer, Patient Financial Advocacy Network 2021 – Seattle
  • Attendee, 15 Annual Healthcare Collections & Insurance Follow-Up Webinar Series 2024
  • Certified Revenue Cycle Representative (CRCR) - Healthcare Financial Management Association (HFMA), 2016
  • Affiliate, Society for Insurance Denial Management Professionals (SIDMP) 2020 – Present
  • Guest Speaker, Health Insurance Denial Management Conference 2017
  • Completion, Revenue Cycle Management Certificate Course, Summit Group 2018

Certifications

  • SHRM Senior Certified Professional (SHRM-SCP)
  • Cisco Certified Internetwork Expert (CCIE)
  • Healthcare Collections Specialist Certification
  • Certificate in Healthcare Revenue Management Systems from HFMA
  • Health Insurance Specialist Certificate Program
  • Certified Specialist Business Intelligence (Healthcare Data Analysis) by HFMA
  • Certified Medical Reimbursement Specialist (CMRS)
  • First Aid/CPR
  • Microsoft Certified Systems Engineer (MCSE)
  • Cisco Certified Network Associate (CCNA)

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