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Skills

  • Policy change implementation
  • Portfolio health plan management
  • Appointment scheduling optimization
  • Account management
  • Customer service
  • Organization
  • Data analysis and reporting
  • Cost-saving contract negotiations
  • Documentation abilities
  • Care management program development

Work Experiences

  • Analyzed implementation of new managed care programs.
  • Analyzed healthcare cost trends to inform plan design changes, projecting a potential annual cost reduction of $18.
  • Assisted in conducting cost-benefit analysis.
  • Collaborated with a multidisciplinary team to address escalated claims issues, reducing complaint resolution time from one year to procedure.
  • Was able to effectively communicate with members of the operations, finance, and clinical departments.
  • Contributed to a reduction of 19% in network costs.
  • Had an excellent attendance record and was always on time for work.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Achieved a 23% reduction in errors.
  • Kept patient finances, records, and health statuses confidential.

Summaries

  • Achieved 81% increase in member satisfaction.
  • Boosted engagement by 23%.
  • Offering 6 years of experience as well as the willingness to take on any challenge.
  • Adept at managing complex caseloads.
  • Adept at reducing readmission rates.
  • Bringing 15 years of insurance experience to the table.
  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • Adaptable Managed Care Representative.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Within Miscellaneous, senior Managed Care Representative and outstanding performer in cross-functional collaboration and data analysis.

Accomplishments

  • Assisted in contract renegotiations that delivered cost savings of $17 over one year for healthcare network reimbursements.
  • Processed and reviewed 8% of managed care claims, maintaining a 16% accuracy rate over several months.
  • Streamlined invoice validation, reducing processing errors by 77% while maintaining adherence to health plan policies.
  • Initiated a new patient care coordination program that resulted in 5% improvement in HEDIS measures in 2015.
  • Collaborated with team of 4 in the development of system.
  • Collaborated with providers to minimize overpayment errors, resulting in 78% fewer audit findings month over month.
  • Efficiently collaborated with the legal team to resolve contract disputes and prevent potential losses of $10.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Successfully reduced specialty denial rates across the network by 45% through diligent follow-ups and provider outreach.
  • Monitored key performance indicators, ensuring the department achieved a claim resolution rate above 41% for 14 consecutive months.

Affiliations

  • Project Management Institute (PMI) - Participant in Healthcare-Specific Project Management courses, focused on process improvement
  • International Association of Administrative Professionals
  • Society of Human Resource Management
  • National Association of Social Workers
  • Society for Healthcare Strategy & Market Development (SHSMD) - Monthly contributor on payer communication strategies
  • America’s Health Insurance Plans (AHIP) - Completed procedure in 2021
  • Medical Group Management Association (MGMA) - Completed ITIL focused on provider network management
  • American College of Healthcare Executives (ACHE) - Member, completed leadership seminars in 2020
  • Fellow of the Academy for Healthcare Management (FAHM) - Certification earned in 2016 focusing on quality improvements in managed care
  • American College of Emergency Physicians (ACEP) - Contributing member, participated in managed care policy discussions

Certifications

  • Certified in Federal Healthcare Program Compliance (CHPC)
  • Google Certified Professional Cloud Architect
  • Apple Certified Associate (ACA)
  • Lean Healthcare Certification by Ironclad Systems
  • Certified Provider Credentialing Specialist (CPCS)
  • Certified Business Analysis Professional (CBAP)
  • Certificate in Managed Care Pharmacy (CMCP) by Brightline
  • Certified Medical Office Manager (CMOM)
  • Microsoft Certified Systems Engineer (MCSE)
  • CompTIA A+ Technician

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