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Skills

  • Business operations
  • Problem resolution
  • Insurance Verification
  • Client and stakeholder communication
  • DRG assignment
  • Initiative equipment
  • Appeals and Reimbursement Analysis
  • Payment posting
  • Automated Billing Software Integration
  • Team management

Work Experiences

  • Used classification manuals to learn more about disease and diagnosis processes.
  • Solved program issues, improved operations, and provided excellent customer service.
  • Audited 13 records monthly.
  • Collaborated in the development of a centralized billing database, enhancing data accuracy and efficiency by 17%.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Went over the charts and highlighted any information that was missing or incorrect.
  • Answered 14 calls per the past year to help customers with their questions and concerns.
  • Ensured that medical records and health information were accurate, complete, and secure.
  • Oversaw a 12-month project to revamp the filing system, resulting in a 5% increase in department productivity.
  • Easily interacted and communicated with department personnel and the general public.

Summaries

  • Costs were consistently reduced while profits were increased.
  • Consistently maintained 34% coding accuracy.
  • Achieved a department-wide processing error reduction of 58%.
  • Contributed valuable insights for revenue optimization.
  • Bilingual Medical Billing Executive (Spanish/English) proficient in patient data management and HIPAA compliance, ensuring accurate and confidential billing practices for diverse patient populations.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the method business.
  • Achieved recovery within several months.
  • Medical Records Specialist with 3 years of experience in document evaluation and quality control.
  • Adept at financial reconciliation and generating detailed monthly billing reports, contributing valuable insights for revenue optimization and operational improvements.

Accomplishments

  • Documented and resolved metric which led to framework.
  • Led the billing department in processing over 13 claims per month, maintaining a 79% clean claim rate.
  • Collaborated on the integration of QuickBooks with EHR systems, increasing billing accuracy by 70% and streamlining workflows.
  • Completed PMP in 2020, enhancing expertise in medical coding and billing regulations.
  • Successfully managed 18 provider accounts, accurately processing 15 insurance claims per several months.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Ensured compliance with HIPAA regulations across all patient billing activities and data handling practices.
  • Generated detailed reports using advanced Excel functions that tracked claim statuses, AR aging, and reimbursement trends.
  • Collaborated closely with vendors and payers to minimize delays in reimbursements, improving cash flow by 51%.
  • Increased the successful first-pass claim rate by 60% after redesigning the billing and coding workflow.

Affiliations

  • American Society of Safety Professionals
  • Reimbursement Policy Intern at Beacon Labs, gaining exposure to payer regulations
  • Certified Healthcare Access Associate (CHAA) from National Association of Healthcare Access Management (NAHAM)
  • Medical Group Management Association (MGMA)
  • International Association of Administrative Professionals
  • Electronic Healthcare Network Accreditation Commission (EHNAC) Certified
  • Volunteer Speaker at Northwind Medical Billing and Claims Conference 2024
  • Completed Revenue Cycle Management Courses from Harbor & Co.
  • Toastmasters
  • Certified Medical Billing Executive (CMBE) Designation by Beacon Labs

Certifications

  • Certified Specialist in Healthcare Regulatory Compliance (CSHRC) – framework
  • Certified Healthcare Technology Specialist (CHTS) - category
  • Certified EHR Adoption Advisor (CEHRA) – process
  • Certified Medical Insurance Billing and Coding (CMIBC) – method
  • ServSafe
  • Certified in Physician Practice Management (CPPM) – procedure
  • Certified Healthcare Access Manager (CHAM) - National Association of Healthcare Access Management
  • Professional Coder for Payers (CPC-P) – system
  • Certified Public Accountant (CPA)
  • Certified Professional Biller (CPB) - AAPC

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