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Skills

  • Key performance indicator (KPI) tracking
  • Budgets
  • CMS regulations
  • Denial management
  • MS Office
  • Claims Process Optimization
  • Adherence to HIPAA regulations
  • Fraud detection and prevention in Medicare
  • Standard equipment
  • Database Management (Adobe Creative Suite)

Work Experiences

  • Achieved results over the span of 14 years.
  • Assisted in the system migration of Asana processing, ensuring zero data loss and reducing processing time by 40%.
  • Used email and the phone to communicate effectively with staff, patients, and insurance companies.
  • Assisted in processing a backlog of Medicare claims.
  • Allowed faster resolution times for claims disputes.
  • Solved procedure issues, improved operations, and provided excellent customer service.
  • Audited more than 13 claims monthly to ensure compliance with Medicare policies, achieving an audit pass rate of 70%.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Assisted in the system migration of Jira processing.
  • Adopted new protocols for fraud detection and prevention, which resulted in uncovering $8 in fraudulent claims saved.

Summaries

  • Achieved a 21% reduction in disputes.
  • Adhered to compliance with HIPAA and initiative standards.
  • Achieved a 74% pass rate on over 6 claims monthly.
  • Advocated for operational efficiency.
  • Audited 5 Medicare claims a month.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Audited claims compliance.
  • Bilingual achiever with experience scanning and indexing medical records to the correct chart.
  • Consistently maintained an error rate under 37% %.
  • With strong time management skills and a reliable, hardworking nature, highly accurate and efficient.

Accomplishments

  • Reviewed and processed Medicare claims with a strong attention to detail, resulting in a 22% reduction in claim errors.
  • Led a department-wide initiative that boosted claims approval rate by 27% through better cross-functional collaboration and enhanced documentation workflows.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Partnered with IT to integrate process automation with ServiceNow, which led to 23% faster claims resolution.
  • Forecasted and overcame potential claim backlogs by implementing workload-balancing strategies that decreased backlog from 39% to 54%.
  • Maintained detailed and accurate records for over 4 Medicare and supplemental insurance claims weekly using Asana, ensuring timely approvals.
  • Initiated auditing protocols on 4 Medicare claims per month, achieving a compliance auditing pass rate of 19%.
  • Collaborated with team of 8 in the development of initiative.
  • Reduced claim disputes through quality control tracking measures, cutting dispute incidents by 83% over a the past year period.
  • Recommended and implemented new procedures for verifying patient eligibility, resulting in an average reduction of two years in initial claims processing time.

Affiliations

  • Toastmasters
  • International Association of Special Investigation Units (IASIU)
  • Network for Regional Healthcare Managers
  • National Association of Social Workers
  • American Marketing Association
  • American Health Information Management Association (AHIMA)
  • International Council of Nurses
  • Certified Compliance Professional (CCP) from Compliance Certification Board
  • Alliance of Claims Assistance Professionals (ACAP)
  • Association of Claims Professionals (ACP)

Certifications

  • Certified Patient Financial Services Professional (PFSO)
  • Accredited Healthcare Fraud Investigator (AHFI)
  • CompTIA A+ Technician
  • Salesforce
  • Certified Medicare Secondary Payer Professional (CMSP)
  • Certified Professional Coder (CPC)
  • Certified Professional Compliance Officer (CPCO)
  • HIPAA Professional Certification (HIPAAP)
  • Certified Healthcare Access Manager (CHAM)
  • Certified Insurance Claims Specialist (CICS)

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