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Skills

  • Medicare and Medicaid claims processing
  • Medical billing review and reconciliation
  • Fraud detection and prevention
  • Impactful written communication in claims
  • Regulatory compliance
  • Budgets
  • Team building
  • Adaptation to New Healthcare Technologies
  • Team management
  • Method equipment

Work Experiences

  • Achieved a 22% improvement in medical claims coding accuracy.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Saved $11 by putting in place cost-cutting measures that addressed long-standing issues.
  • Achieved a 15% reduction in complaints received by policyholders.
  • Transported QuickBooks to 18 months customer locations.
  • Analyzed complex insurance claims related to Asana.
  • Achieved cost savings totaling over $4 in 2022.
  • Advised on coverage limits and claim procedures.
  • Identified insurance coverage limitations with a thorough examination of claims documentation and related records.
  • Achieved results across a three years period.

Summaries

  • Collaborative Medical Insurance Examiner with expertise in cross-functional work with underwriters and legal teams, mitigating litigation risks by 82% and resolving high-value claims efficiently.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 43% reduction in processing time.
  • Ambitious Medical Insurance Examiner skilled at identifying cost-saving opportunities, resulting in $14 in savings and a 79% increase in overall compliance improvements.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Achieved $17 in savings.
  • Accomplished a 73% rise in approved claims.
  • Review documentation and assess properties efficiently to determine damage levels, complete cost estimates, and maintain liability control.
  • By applying all policies fairly, she is adept at balancing business and customer interests.
  • Empathy, dependability, and enthusiasm for customer satisfaction.

Accomplishments

  • Assessed compliance trends over the past year, resulting in the optimization of claim review processes and a 22% improvement in regulatory alignment.
  • Assisted in automating manual entry processes, resulting in a 43% reduction in clerical errors for claims submitted between 2019 and 2024.
  • Restructured claims workflows by integrating new claims management software SAP, which reduced claim turnaround time by 76%.
  • Served as the point of contact for high-profile clients, leading negotiations on disputed claims and recovering over $4 while maintaining client relationships.
  • Reviewed claims for high-cost medical treatments, resulting in a verified savings of $2 by preventing overpayments.
  • Worked cross-functionally on a project that reduced the number of pending claims by 66% through collaborative problem-solving and team accountability.
  • Mentored junior examiners on best practices for reviewing claims, leading to improved team accuracy by 29% over 18 months.
  • Implemented an electronic records management system that reduced paperwork processing time by 56% and improved accuracy.
  • Developed a new audit procedure that reduced post-audit correction rates from 46% to 79% within 6 months.
  • Resolved product issue through consumer testing.

Affiliations

  • CERT Training Program – Completed coursework and certifications in claims efficiency development and insurance technology applications.
  • International Claim Association (ICA) – Networking with industry peers to stay up-to-date with litigation and policy developments in claims handling.
  • National Association of Insurance Commissioners (NAIC) – Contributed to working groups focused on drafting state-level insurance regulations.
  • Healthcare Financial Management Association (HFMA) – Engaged in learning about current trends impacting health care revenue cycles.
  • Association for Computing Machinery
  • American Society of Healthcare Risk Management (ASHRM) – Maintained professional membership to refine methodologies for analyzing claim-related risks.
  • Society of Corporate Compliance and Ethics (SCCE) – Participation in seminars focused on ensuring adherence to evolving healthcare legislation.
  • American Society of Safety Professionals
  • Society of Actuaries (SOA) – Affiliate membership to strengthen quantitative analysis skills related to premium deductions and reimbursement estimates.
  • Association of Information Technology Professionals

Certifications

  • Certified Managed Care Professional (CMCP)
  • CompTIA Security+
  • Certified in Patient Account Management (CPAM) - American Association of Healthcare Administrative Management
  • Advanced Coding Specialist Certification (ACS-AN) - Board of Medical Specialty Coding & Compliance
  • SHRM Certified Professional (SHRM-CP)
  • Certified Public Accountant (CPA)
  • Certified Healthcare Financial Professional (CHFP) – initiative
  • Google Certified Professional Cloud Architect
  • Certified Business Analysis Professional (CBAP)
  • Certified Insurance Examiner (CIE) - International Claim Association (ICA)

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