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Skills

  • Case manager training and productivity improvement
  • Drug inventory management
  • Medication dispensing
  • Patient education and counseling
  • Claims accuracy improvement
  • Staff management
  • Process improvement and streamlining
  • Loss prevention management
  • Training and development
  • Hiring and recruitment

Work Experiences

  • Analyzed clinical and financial data to identify improvement areas, resulting in a 44% increase in cost avoidance for high-utilization members.
  • Achieved results over 2022.
  • Achieved a 34% reduction in medical costs for members.
  • Collaborated with health service agencies.
  • Analyzed utilization trends.
  • Achieved $17 savings during 2024.
  • Cleaned up the pharmacy area by removing trash and straightening the counters.
  • Adopted company-wide.
  • Collaborated with finance, claims, and third-party vendors.
  • Communicated with patients while maintaining the confidentiality of their medical information.

Summaries

  • Costs were consistently reduced while profits were increased.
  • Develop and lead an office staff that is productive and efficient.
  • Achieved 45% enhancement in regulatory adherence.
  • Expert at streamlining processes, increasing team productivity, and lowering costs to ensure long-term nursing home operations.
  • Staff development that results in high-performing teams has been recognized.
  • Professional with experience in recruiting, training, and managing employees to provide exceptional resident services in the healthcare industry.
  • Strong organizational skills, as well as a thorough knowledge of data collection and performance metrics.
  • Advanced proficiency in healthcare regulation compliance, consistently improving organizations' audit scores by 23%, securing critical partnerships.
  • Analyzed clinical data.
  • Process improvement and risk assessment experts.

Accomplishments

  • Optimized member service protocols, decreasing overall provider response times by 77% and improving member satisfaction ratings.
  • Expertly renegotiated existing payer contracts, securing 54% more favorable terms for Summit Group and reducing overall costs by $165,000.
  • Managed healthcare data reporting for 7 managed care contracts, increasing accuracy and timeliness of submissions by 38%.
  • Collaborated with HR and compliance teams to develop new managed care training aimed at reducing errors and improving claims accuracy by 60%.
  • Developed and launched a member satisfaction program which increased overall satisfaction scores by 85% across 14 states.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Created and implemented reimbursement training programs that improved claim approval rates by 64% while reducing appeals.
  • Facilitated contract renegotiations with 15 payers, achieving 24% more favorable terms for the organization.
  • Collaborated with team of 11 in the development of program.
  • Analyzed member satisfaction surveys and implemented actionable improvement steps that increased satisfaction rates by 85%, reversing previous negative trends.

Affiliations

  • Association of Information Technology Professionals
  • American Society of Safety Professionals
  • Executive Committee member focusing on care management within the National Association for Healthcare Quality (NAHQ)
  • Active Participant in Healthcare Claims Residential Group (HCRG)
  • National Committee for Quality Assurance (NCQA) Practitioner (Led accreditation efforts in managed care programs)
  • Member of the Academy of Managed Care Pharmacy (AMCP)
  • Completed Certification in Clinical Documentation Improvement w/ Focus on Managed Care
  • Networking Expansion Task Force Leader at Health Plan Association 2017
  • Certified Professional in Healthcare Quality (CPHQ) - Specialized in network quality improvement
  • American Public Health Association (APHA) Affiliate focused on Managed Care and Policy Trends

Certifications

  • Advanced Healthcare Analytics Certification – Vantage, 2021
  • Association for Advancing Physician and Provider Recruitment (AAPPR) Certification – 2020
  • Healthcare Compliance Certification (CHC) – HCCA, 2015
  • Strategic Account Management Association (SAMA) Certification 2021
  • Certified Revenue Cycle Specialist (CRCS) - Summit Group, 2022
  • Certified Health Data Analyst (CHDA) - Brightline, 2017
  • Certified Professional in Healthcare Information and Management Systems (CPHIMS) – HIMSS, 2019
  • Certified Coding Associate (CCA) – AHIMA, 2020
  • Certified Professional in Healthcare Risk Management (CPHRM) - Northwind, 2022
  • Project Management Professional (PMP) - process

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