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Skills

  • Relationship development
  • Data Analysis for Process Improvement
  • Effective communication with healthcare providers and patients
  • Project organization
  • Team building
  • Organization
  • Medical claims reconciliation
  • Customer service
  • Budgets
  • Medical claims adjudication

Work Experiences

  • Awarded in 2023.
  • Achieved a 77% decrease in rework.
  • Achieved recoveries worth $7.
  • Achieved accurate decisions within regulatory timeframes.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Had an excellent attendance record and was always on time for work.
  • Adjudicated claims effectively.
  • Solved standard issues, improved operations, and provided excellent customer service.
  • Achieved results over the past year.
  • Achieved this reduction over a one year period.

Summaries

  • Analyzed claims performance through advanced reporting tools.
  • Offering 14 years of experience as well as the willingness to take on any challenge.
  • Consistently delivered on time.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Consistently exceeds performance targets in medical claims resolution, identifying areas for improvement and helping teams optimize processes for 61% gains in workflow efficiency.
  • Analytical mindset focused on investigating patterns.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • Addressed complex claims issues.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.

Accomplishments

  • Collaborated with team of 13 in the development of metric.
  • Filed and processed over 2 claims monthly, ensuring compliance with insurance protocols and reducing denials by 65%.
  • Implemented a flagging system within the claims process to identify high-risk claims, reducing the rate of fraudulent activity by 48%.
  • Implemented strategies that resulted in the recovery of $13 in disputed claims, with an overall success rate of 80%.
  • Reviewed and interpreted complex policy statements to ensure accurate billing, leading to a 63% reduction in claim rejections.
  • Performed in-depth case review and appeals that resulted in the reversal of 48% of initially denied claims.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Successfully negotiated with insurance providers to secure higher reimbursement rates, increasing revenue by $18 in 2023.
  • Proactively identified and corrected coding errors affecting claims submissions, contributing to a decrease in denied claims by 28%.
  • Resolved escalated claims issues leading to a 57% decrease in customer complaints over two years.

Affiliations

  • International Council of Nurses
  • Rotary International
  • National Association of Healthcare Revenue Integrity (NAHRI)
  • Institute of Healthcare Management (IHM)
  • American Medical Billing Association (AMBA)
  • American Hospital Association (AHA)
  • National Association of Social Workers
  • Credentialed Insurance Billing Specialist (CIBS)
  • National Association of Health Data Organizations (NAHDO)
  • Medical Group Management Association (MGMA)

Certifications

  • Medicare Set-Aside Certified Consultant (MSCC)
  • Medical Insurance Coding & Billing Certificate
  • Certified Medicare Secondary Payer Professional (CMSP)
  • Certified Health Insurance Professional (CHIP)
  • Salesforce
  • Certified Claims Professional Accredited (CCPA)
  • Cisco Certified Network Associate (CCNA)
  • Certificate in Healthcare Risk Management
  • Associate in Claims (AIC)
  • Certified Coding Associate (CCA)

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