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Skills

  • Operational improvement
  • Process improvement
  • Data analysis and reporting
  • Communications
  • Business operations
  • Conflict resolution
  • Problem resolution
  • HIPAA regulations
  • DRG assignment
  • Compliance with payer contracts

Work Experiences

  • Analyzed Asana incident reports.
  • Clarified key medical policies.
  • Collaborated with the IT team to develop automation tools for medical file reviews, reducing manual error rates by 21%.
  • Achieved recovery within several months.
  • Collaborated with cross-functional teams, including physicians and compliance departments, to resolve discrepancies and improve data accuracy by 32%.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Used email and the phone to communicate effectively with staff, patients, and insurance companies.
  • Analyzed trends in denied claims and provided actionable insights that resulted in the recovery of over $11 in improper rejections within the past year.
  • Achieved results within three years.
  • Collaborated with coding and billing teams.

Summaries

  • Achieved a 65% decrease in denied claims.
  • A highly capable Medical Review Analyst with a talent for aligning review procedures with regulatory requirements, leading to a major 84% reduction in claim denial rates.
  • Contributed to a 17% reduction in errors.
  • Medical Review Analyst with over 13 years of experience in the healthcare field.
  • Achieved strategic process improvements.
  • Achieved a 40% error reduction in medical claim assessments.
  • Achieved a 18% reduction in medical review errors.
  • Conducted regular random audit reviews.
  • Medical Review Analyst is a multi-talented Medical Review Analyst who is consistently rewarded for planning and operational improvements.
  • Contributed to a 75% increase in claims accuracy.

Accomplishments

  • Led a departmental restructuring effort and decreased operational costs by 38% while maintaining service quality.
  • Monitored the accuracy of clinical incident reports and pursued corrective action, decreasing report errors by 67%.
  • Resolved product issue through consumer testing.
  • Implemented best practice guidelines across medical review processes, increasing overall team throughput by 25% cases per day.
  • Collaborated with IT to improve claims adjudication software, increasing auto-adjudication rates by 60%.
  • Recommended system improvements with third-party vendors to correct recurring documentation errors, decreasing unpaid claims by 73%.
  • Reduced patient complaint cases by 77% through focused improvements on stakeholder communication and case resolution procedures.
  • Performed root cause analyses on escalated claims, reducing recurring issues by 40% and enhancing customer satisfaction.
  • Collaborated with compliance teams to mitigate risk factors, resulting in a 77% decrease in regulatory violations.
  • Provided detailed analyses of method cases, allowing for more accurate evaluations and reducing appeals by 59%.

Affiliations

  • American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Certified
  • American Society for Health Care Risk Management (ASHRM) Member
  • International Medical Informatics Association (IMIA) Member
  • National Association of Medical Examiners (NAME) Member
  • American Society of Safety Professionals
  • American Medical Review Officers (MRO) Association Member
  • Freemason
  • Clinical & Laboratory Standards Institute (CLSI) Member
  • American Statistical Association (ASA) - Healthcare Statistics Division
  • Association for Computing Machinery

Certifications

  • CompTIA A+ Technician
  • Healthcare Compliance Certification (CHC) - HCCA
  • Certified Risk Adjustment Coder (CRC) - category
  • Certified Fraud Examiner (CFE) - procedure
  • Certified Professional in Healthcare Quality (CPHQ) - method
  • Certified Business Analysis Professional (CBAP)
  • Credentialed Clinical Research Associate (CCRA) - Northwind
  • Certified Health Data Analyst (CHDA) - process
  • Certified Clinical Research Professional (CCRP) – SOCRA
  • Salesforce

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