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Skills

  • Claims Process Optimization
  • MS Office
  • Records review
  • 3M Encoder
  • Effective communication with medical providers
  • Denial management
  • Customer service excellence
  • Leadership in operations improvement
  • Customer service
  • Data entry with high accuracy

Work Experiences

  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Achieved a 22% decrease in processing anomalies.
  • Achieved a 49% improvement in processing time.
  • Assisted in the system migration of Jira processing.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Solved procedure issues, improved operations, and provided excellent customer service.
  • Assisted in closing 3 claims.
  • Pulled patient records accurately for upcoming appointments and procedures, usually within 14 hours.
  • Achieved results within several months.
  • Achieved faster payment timelines.

Summaries

  • Consistently achieved claim accuracy rates above 30%.
  • Achieved a 74% pass rate on over 6 claims monthly.
  • Bilingual achiever with experience scanning and indexing medical records to the correct chart.
  • Achieved a pass rate of 41%.
  • Within Miscellaneous, senior Medicare Claims Processor and outstanding performer in workflow optimization and performance reporting.
  • Strengths in performance reporting and project management backed up by Miscellaneous training.
  • Achieved a claim approval rate of over 82%.
  • Consistently maintained an error rate under 37% %.
  • Advocated for operational efficiency.
  • Adept in CPT and ICD-10 coding.

Accomplishments

  • Reduced processing costs by $11 annually by implementing key efficiency changes to the claims submission process.
  • Assumed leadership roles in training new claims processors, resulting in a 77% decrease in onboarding time for new hires.
  • Monitored and adjusted workflow patterns within the claims processing department, boosting output by 78% while reducing duplicate or erroneous entries.
  • Reviewed and processed Medicare claims with a strong attention to detail, resulting in a 22% reduction in claim errors.
  • Resolved over 2 complex Medicare claims disputes within a three years, improving customer satisfaction and cutting dispute resolution time by 73%.
  • Processed over 11 Medicare claims monthly while maintaining one of the highest accuracy ratings at 26%.
  • Forecasted and overcame potential claim backlogs by implementing workload-balancing strategies that decreased backlog from 39% to 54%.
  • Oversaw escalated Medicare claims, achieving a 34% success rate in closing long-standing issues within 18 months.
  • Trained over 14 staff members on updated Medicare policies and technologies, ensuring compliance with 2018 regulatory changes.
  • Initiated auditing protocols on 4 Medicare claims per month, achieving a compliance auditing pass rate of 19%.

Affiliations

  • American Medical Billing Association (AMBA)
  • American Society for Quality (ASQ)
  • International Association of Special Investigation Units (IASIU)
  • National Association of Health Underwriters (NAHU)
  • Healthcare Financial Management Association (HFMA)
  • Membership in Medicare Services Advisory Groups
  • Association for Computing Machinery
  • Association of Billing and Coding Professionals (ABCP)
  • Professional Association for Healthcare Coding Specialists (PAHCS)
  • National Medicare Training Program

Certifications

  • Certified Coding Specialist (CCS)
  • Certified Professional Compliance Officer (CPCO)
  • Certified Business Analysis Professional (CBAP)
  • Certified Public Accountant (CPA)
  • CompTIA Security+
  • Certified Fraud Examiner (CFE)
  • Nationally Certified Medical Biller (NCMB)
  • Certified Professional Medical Auditor (CPMA)
  • CompTIA A+ Technician
  • Certified Billing and Coding Specialist (CBCS)

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