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Skills

  • Automation software proficiency (Tableau)
  • Performance tracking and optimization
  • Payment resolution with insurance carriers
  • Leadership and personnel supervision
  • Cross-functional team leadership
  • Claims accuracy auditing
  • Project organization
  • Conflict resolution
  • Billing and Reimbursement Management
  • Claims Dispute Resolution

Work Experiences

  • Achieved recovery over 13 months.
  • Transported Tableau to three years customer locations.
  • Oversaw the delivery of category project by metric team, which resulted in system.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Looked for industry trends on social media and through online sources.
  • Conducted monthly audits.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Achieved backlog reduction within several months.
  • Addressed disputes on high-risk claims.

Summaries

  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • Within Miscellaneous, senior Medical Claims Supervisor and outstanding performer in team leadership and client relations.
  • Data-focused Medical Claims Supervisor.
  • Achieved a 59% increase in productivity.
  • Accomplished claims supervisor.
  • Achieved a productivity increase of 19%.
  • Bringing 15 years of insurance experience to the table.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate process systems is one of my specialties.
  • Cut costs for Brightline.

Accomplishments

  • Developed a comprehensive training program that improved claims adjudication accuracy by 43% within the first 15 weeks of implementation.
  • Established robust communication channels with healthcare providers, leading to a streamlined documentation process and a 74% improvement in initial claim approvals.
  • Managed relationships with third-party administrators to ensure seamless claim submissions and accelerated payments, resulting in 62% reduction in average claim processing time.
  • Analyzed weekly audit reports to ensure compliance with internal procedures, reducing fraud incidents by 40%.
  • Introduced a claims escalations dashboard that tracked bottlenecks and enabled faster resolutions, cutting down escalation time by 79% days.
  • Enhanced claims auditing process, leading to the identification of discrepancies amounting to $141,000 and subsequent cost recovery.
  • Developed and implemented analytic reports to monitor claims trends, resulting in an 40% improvement in operational efficiency.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Reviewed and prioritized appeals backlog, reducing claim payout delays by three years.
  • Improved payer communication strategies, significantly reducing outstanding claims aging beyond 9 days by 61%.

Affiliations

  • Health Industry Distributors Association (HIDA)
  • Association for Supply Chain Management (APICS)
  • Society of Human Resource Management
  • National Association of Social Workers
  • Certified in Healthcare Compliance (CHC)
  • American College of Healthcare Executives (ACHE)
  • American Hospital Association (AHA)
  • National Health Care Anti-Fraud Association (NHCAA)
  • American Society of Safety Professionals
  • Institute for Healthcare Improvement (IHI)

Certifications

  • Certified Business Analysis Professional (CBAP)
  • Certified Public Accountant (CPA)
  • Certified Medical Office Manager (CMOM) - 2021
  • Certified Healthcare Financial Professional (CHFP) - 2024
  • ServSafe
  • Professional Risk Manager Certification (PRM) - Harbor & Co., 2018
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Revenue Cycle Professional (CRCP) - 2024
  • Managed Healthcare Professional (MHP) Certification - Ironclad Systems, 2023
  • Certified Professional in Healthcare Risk Management (CPHRM) – 2015

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