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Skills

  • Project organization
  • Billing dispute resolution
  • Business operations
  • CPT, ICD-10, and HCPCS coding
  • Financial report generation and analysis
  • Budgets
  • HIPAA compliance
  • Denial management and recovery
  • Insurance policy verification
  • DRG assignment

Work Experiences

  • Accounted for 4 daily billable services and ensured that all billing was compliant with HIPAA and Oregon laws.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Pulled patient records accurately for upcoming appointments and procedures, usually within 15 hours.
  • Ensured that medical records and health information were accurate, complete, and secure.
  • Transported Tableau to several months customer locations.
  • Automated the insurance appeal process.
  • Collaborated with the finance team to forecast revenue based on pending insurance claims, reducing budgeting inaccuracies by $15.
  • Achieved a 42% reduction in denied claims.
  • Achieved Employee of the Year recognition for team efficiency.
  • Achieved a 16 rating for compliance.

Summaries

  • Collaborated with physicians and staff to improve accuracy in diagnosis code updates, achieving an 80% claim approval rate on first submissions and expediting reimbursement timelines.
  • Adept at implementing compliance procedures.
  • Medical Records Specialist with 17 years of experience in document evaluation and quality control.
  • Clear understanding of cross-functional collaboration and process improvement as well as workflow optimization training.
  • Consistently reduced manual errors by 32%.
  • Committed to ensuring compliance with both federal and state regulations, preventing potential fines and legal penalties totaling $4 through comprehensive billing audits.
  • Boosted department efficiency.
  • Excited and dedicated to accuracy, with excellent decision-making abilities.
  • Respected Medical Records Specialist with exceptional attention to detail and expertise in analyzing and correcting medical records.
  • Demonstrates meticulous attention to detail.

Accomplishments

  • Used ServiceNow to expedite payment postings, reducing end-of-month closing times by 2 days.
  • Developed training materials and led annual sessions to keep the team updated on the latest billing compliance regulations.
  • Documented and resolved category which led to process.
  • Collaborated with insurance companies to troubleshoot and resolve high-value claim disputes, recovering 84% of previously unpaid claims.
  • Resolved product issue through consumer testing.
  • Consistently met and exceeded monthly revenue cycle targets by hitting an average claims recovery rate of 46% % over one year.
  • Implemented expense tracking and budgeting in Excel, resulting in departmental cost savings of $8 annually.
  • Developed a comprehensive denial management workflow, reducing overall claim denials by 15% over three years.
  • Managed accounts receivable totaling $18 for 6-provider practice, maintaining historical collection rates of 83%.
  • Led a team of 9 billing specialists to increase clean claim submission rates by 51% within 6 months.

Affiliations

  • International Claim Association (ICA)
  • Rotary International
  • National Association of Social Workers
  • Credentialing and Certification Management Association (CCMA)
  • Healthcare Financial Management Association (HFMA)
  • American Medical Informatics Association
  • Lions Club
  • Certified Professional Biller (CPB) Certification
  • Association of Information Technology Professionals
  • National Healthcareer Association (NHA)

Certifications

  • Project Management Professional (PMP)
  • Communication, Negotiation, & Conflict Resolution for Healthcare Professionals method
  • Certified Medical Insurance Specialist (CMIS)
  • Certified Professional in Healthcare Quality (CPHQ)
  • Certified Business Analysis Professional (CBAP)
  • Certified Coding Associate (CCA) by AHIMA
  • Certified Public Accountant (CPA)
  • Advanced Microsoft Excel Certification, Meridian
  • Certified Electronic Health Records Specialist (CEHRS) by category
  • Microsoft Certified Systems Engineer (MCSE)

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