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Skills

  • Team management
  • Insurance billing
  • Training and mentoring
  • Customer service
  • Analytical thinking
  • Supervision
  • First Aid/CPR
  • Accuracy in high-complexity claims
  • Audit preparedness and execution
  • First-pass resolution improvement

Work Experiences

  • Finished procedure of project, which resulted in process.
  • Conducted departmental assessments.
  • Collaborated with healthcare providers.
  • Communicated effectively with providers and patients.
  • Acted as a subject matter expert during departmental audits.
  • Collaborated closely with team members to meet project deadlines, develop solutions, and deliver project requirements.
  • Collaborated with the billing department to ensure proper processing of claims, resolving 5 billing issues and expediting revenue capture.
  • Assisted in pre-adjudication investigations of flagged claims.
  • Collaborated with the billing department.
  • Collaborated with legal teams to ensure compliance with all HIPAA regulations, mitigating risk during claims processing.

Summaries

  • Communicative and team-oriented, with Tableau expertise.
  • Miscellaneous student seeking hands-on experience through an internship in workflow optimization.
  • Expert in metric with a strong aptitude for automated and optimized.
  • With 8 years of experience and a willingness to take on any challenge, I'm ready to take on any challenge.
  • Accomplished Claims Analyst with 6 years of experience reducing rejected claims by 46% through regulatory auditing and compliance enforcement. Expertise in complex claim adjudication with a focus on improving turnaround times.
  • Vendor management in standard settings and vendor management in quality assurance settings.
  • Strategic thinker with expertise in team leadership.
  • Professional with a track record of managing large caseloads in fast-paced environments who is organized, driven, and adaptable.
  • Medical Claims Analyst and team leader with 18 years of experience in program settings.
  • Results-oriented Miscellaneous professional with process improvement, team leadership, and performance reporting strengths.

Accomplishments

  • Maintained a 15% customer satisfaction score by resolving provider and patient claims within 4 days, reducing overall resolution time.
  • Facilitated communication between providers and patients, decreasing claim escalation cases by 36% in 2017.
  • Trained 13 new hires on the claims analysis process, contributing to a 67% increase in team productivity after program implementation.
  • Reduced the average claims processing time by 36% by introducing new documentation standards and automated workflows.
  • Reduced denied claims by 36% through comprehensive claims investigation and analysis in collaboration with cross-functional teams.
  • Resolved escalated claims within 12 days or less, consistently maintaining a 34% first-call resolution rate.
  • Partnered with providers to clarify claims documentation needs, reducing claim confusion and delays by 69%. Resulting in faster claims settlements.
  • Maintained full adherence to HIPAA guidelines during all claim adjudication and investigation processes, achieving 47% compliance audit success.
  • Collaborated with a cross-functional team to enhance claims adjudication workflows, leading to a 32% decrease in processing time.
  • Reduced claim rework rates by 76% by initiating and executing a quality control program.

Affiliations

  • Active participant in the Billing and Coding Education Program developed through program
  • Certified in Lean Six Sigma for Healthcare, specialized training in process improvement for claims processing, certified in 2016
  • Certified Denials Management Specialist, a professional certification obtained through the American Society for Health Informatics Managers, 2023
  • Member, Healthcare Financial Management Association (HFMA) system
  • Monthly contributor to claims processing educational forums within the American Medical Billers Association (AMBA), 2021-Present
  • Member of Claims Investigation and Adjudication Panel, Portland Chapter of AHIMA, actively involved since 2015
  • Served as a mentor in the Medical Billing and Claims Analyst Mentorship Program in Austin, helping train new analysts, 2020
  • Active affiliation with Regional Chapter of HFMA, focusing on claim adjudication precision and denial management improvements, Raleigh
  • Certified Medical Reimbursement Specialist (CMRS), successfully completed in 2016 through American Medical Billing Association (AMBA)
  • Professional billing and claims processing training via American Health Information Management Association (AHIMA), certified in 2020

Certifications

  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Public Accountant (CPA)
  • AHIMA Certified Coding Specialist (CCS) – Cedar Works
  • SHRM Certified Professional (SHRM-CP)
  • Certified Clinical Documentation Specialist (CCDS) - Vantage
  • Healthcare Access Associate (CHAA) - Meridian
  • Microsoft Certified Systems Engineer (MCSE)
  • Lean Healthcare Certification – Harbor & Co.
  • Certified Billing and Coding Specialist (CBCS) - Ironclad Systems
  • Certified Healthcare Financial Professional (CHFP) - Beacon Labs

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