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Skills

  • First-time claim submission accuracy
  • Customer service
  • Cross-functional team collaboration
  • Process improvement
  • Health policy compliance
  • Inventory management
  • Complex claim correspondence resolution
  • Organization
  • Aged account reconciliation
  • Insurance billing

Work Experiences

  • Collaborated with the billing department on remittance advice tracking strategies, leading to a 18% reduction in claim rework.
  • Collaborated with payers to resolve 13 high-dollar claims, reducing overall denial rate by 63%.
  • Used Tableau to compile data gathered from various sources.
  • Analyzed claim data trends to forecast future issues and made proactive corrections upfront, contributing to a year-over-year 60% reduction in denials.
  • Boosted team performance by 85%.
  • Developed a reputation for punctuality and hard work.
  • Analyzed claim data trends.
  • Kept my metric knowledge up to date by doing data analysis and workflow optimization.
  • Worked with others to brainstorm new system possibilities.
  • Answered 15 phone calls per three years to assist customers.

Summaries

  • Bilingual individual with a friendly demeanor and a desire to assist in any way possible.
  • Ability to recognize category issues and integrate method solutions to achieve category.
  • Achieved a 41% improvement in cash flow.
  • Communicative and team-oriented, with HubSpot expertise.
  • ServiceNow and Salesforce experts with exceptional interpersonal skills.
  • Results-oriented Miscellaneous professional with workflow optimization, vendor management, and quality assurance strengths.
  • Student pursuing a Miscellaneous degree who is eager to contribute developed knowledge in the role of Insurance Follow-up Specialist.
  • Strategic thinker with expertise in performance reporting.
  • Category, standard, and category are all available.
  • With hands-on experience, eager to learn new skills and advance knowledge.

Accomplishments

  • Reduced claim denial rate by 57% through proactive follow-up with payers and improved claim accuracy processes over 18 months.
  • Built strong relationships with 3 insurance carriers to expedite claim resolutions, resulting in 42% fewer backlogged claims.
  • Collaborated with cross-functional teams, including billing and coding, to close over 3 outstanding claims, securing a 22% improvement in accounts receivable timelines.
  • Successfully decreased aging claims over two years by 62% through refined escalation processes and effective payer negotiations.
  • Reclaimed $5 in denied claims over two years through thorough reviews, refiling, and ongoing follow-ups with paired insurance companies.
  • Trained 17 new staff members in insurance follow-up best practices, reducing the learning curve and improving processing accuracy by 46% within two years.
  • Managed an outstanding A/R portfolio of $12, achieving a 78% decrease in overdue balances through early interventions and effective negotiations.
  • Designed and implemented an insurance denial tracking system that pinpointed trends and improved resolution rates by 77% over the past year.
  • Developed a comprehensive documentation process for escalations leading to a 60% reduction in preventable claim denials.
  • Proactively resolved discrepancies on high-dollar accounts within several months, successfully recovering $12 in lost revenue for the company.

Affiliations

  • Member, Institute for Healthcare Improvement (IHI) Revenue Cycle Section 2024 – Present
  • Volunteer, Medical Billing Coding & Compliance Association 2016
  • Active Participant, Medical Group Management Association (MGMA) Insurance Billing and Follow-Up Forum
  • Affiliate, National Healthcare Insurance Association 2024 – Present
  • Member, Patient Accounts Management Association 2018 – Present
  • Graduate or Participant of Healthcare Revenue Cycle Leadership Academy 2021
  • Attendee, Annual National Institute (ANI) for Financial and Clinical Leaders in Healthcare 2016
  • Member, National Association of Health Data Organizations (NAHDO) 2018 – Present
  • Certified Professional Coder (CPC) – American Academy of Professional Coders (AAPC) 2024
  • Member, Healthcare Billing & Management Association (HBMA) 2023 – Present

Certifications

  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Revenue Cycle Specialist (CRCS) by AAHAM
  • CompTIA Network+
  • Certified Professional Coder (CPC) by AAPC
  • Data Analytics for Healthcare Certification
  • Lean Six Sigma Green Belt – Healthcare Focus
  • Healthcare Financial Systems Certification from AHIMA
  • Certified Revenue Integrity Professional (CRIP) from NAHRI
  • Certified Electronic Health Records Specialist (CEHRS) from NHA
  • SHRM Certified Professional (SHRM-CP)

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