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Skills

  • Comprehensive Denied Claims Analysis
  • Confidential patient data handling (HIPAA)
  • Electronic Health Records (EHR) management
  • Team building
  • Supervision
  • Operational improvement
  • Regulatory compliance
  • Business operations
  • Team management
  • Collection Strategies Implementation

Work Experiences

  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Communicated with patients, providers, and payers to ensure timely completion of reimbursement documentation, consistently reducing processing time by 3 days.
  • Achieved timely reimbursements.
  • Achieved results in the past year.
  • Conducted consistent review of billing submissions.
  • Audited reimbursement records for over 2 patient accounts.
  • Collaborated with compliance.
  • Administered reimbursements for medical claims with 15% accuracy, ensuring timely and compliant transactions while adhering to payer policies.
  • Accurately verified patient insurance eligibility for system treatments, directly impacting approval for treatment plans by 84%.
  • Collaborated with external payer representatives.

Summaries

  • Adept at safeguarding confidential patient data.
  • Medical Reimbursement Technician with 5 years of successful workflow optimization and data analysis experience.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Committed to revenue cycle excellence.
  • Compassionate advocate for patients.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Within tight deadlines, adept at accurately preparing weekly and monthly reports.
  • Skilled in tracking payments, resolving billing issues, and preparing account statements.
  • Committed to reducing claim denials.

Accomplishments

  • Monitored and analyzed Workday reports to track reimbursement trends, resulting in more accurate financial forecasting and a 65% increase in collections.
  • Resolved insurance reimbursement discrepancies for 3 patient accounts per month, streamlining the process and reducing delays by 67%.
  • Trained and mentored a team of 11 billing specialists, leading to a department-wide increase in reimbursement efficiency by 19%.
  • Successfully integrated Asana to monitor claims in real-time, improving response times to payer inquiries and decreasing overdue reimbursement rates by 55%.
  • Minimized revenue loss by developing a comprehensive denials management program, which brought denial rates down by 20% year-over-year.
  • Delivered one-on-one training and team workshops on healthcare reimbursement methodologies, boosting department productivity by 31%.
  • Analyzed high-volume claims data to identify recurring denial trends, resulting in improvements that led to a 33% reduction in claim rework.
  • Developed and maintained strong relationships with payers, reducing claim denial rates and increasing successful appeals by 38%.
  • Developed and implemented revenue cycle strategies that contributed to a 6% increase in insurance collections over several months.
  • Provided leadership in special reimbursement projects, recovering $14 in lost revenue through claim corrections and appeals.

Affiliations

  • Healthcare Excellence Institute (HEI)
  • Association of Information Technology Professionals
  • Medical Group Management Association (MGMA)
  • American Medical Informatics Association
  • Certified Professional Biller (CPB) – AAPC Certification
  • Freemason
  • Managed Care and Reimbursement Certification Program
  • Revenue Cycle Analyst Network
  • American Association of Healthcare Administrative Management (AAHAM)
  • Certified Healthcare Access Manager (CHAM)

Certifications

  • Salesforce
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Registered Health Information Technician (RHIT) - AHIMA
  • Project Management Professional (PMP)
  • Healthcare Information Security and Privacy Practitioner (HCISPP) - initiative
  • Accredited Healthcare Fraud Investigator (AHFI) - National Health Care Anti-Fraud Association (NHCAA)
  • Certified Medical Insurance Specialist (CMIS) - Harbor & Co.
  • Cisco Certified Internetwork Expert (CCIE)
  • Compliance Certification (CPCO) - AAPC
  • Certified Specialist Accounting and Finance (CSAF) - Northwind

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