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Skills

  • Hiring and recruitment
  • Correct coding and documentation practices
  • Client satisfaction surveys
  • Medicare compliance training
  • Loss prevention management
  • Claims Denial Reduction Strategies
  • Healthcare claims reconciliation
  • Training and development
  • Communication with Medicaid and insurers
  • Healthy meal preparation

Work Experiences

  • Audited 15 Medicare patient records to identify inaccuracies in claim submission, resulting in savings of $16.
  • Cut average reimbursement delays by three years.
  • Analyzed financial impacts of Medicare trends.
  • Conducted root cause analysis of denied Medicare claims.
  • Created and implemented a leadership development, coaching, and team management model that resulted in employees being promoted to higher levels of responsibility.
  • Collaborated with the finance department to track and report Medicare reimbursements, ensuring accurate monthly postings of $13+.
  • Was in charge of a group of 18 pharmacy technicians.
  • Conducted root cause analysis of high-volume denied Medicare claims, implementing corrective actions that reduced denials by 25%.
  • Decreased escalations.
  • Designed strategy for Medicare Part B billing, reducing submission times to under 10 days, increasing cash flows by $8.

Summaries

  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Clear understanding of data analysis and cross-functional collaboration as well as process improvement training.
  • Achieved zero discrepancies in compliance assessments.
  • Achieved 35% efficiency gains.
  • Performance reporting and project management experts.
  • Strong organizational skills, as well as a thorough knowledge of data collection and performance metrics.
  • Achieved system audit findings.
  • Staff development that results in high-performing teams has been recognized.
  • Adept at negotiating Medicare rates in provider contracts, securing additional revenue streams of $17 for the organization.
  • Excellent planning and program management skills. Highly organized and hardworking.

Accomplishments

  • Developed Medicare prior authorization workflows that increased approval rates by 81%.
  • Facilitated staff training in proper Medicare billing codes, improving accuracy of claim submissions by 83%.
  • Coordinated with compliance to improve the efficiency of Medicare appeals, reducing resolution time by three years.
  • Designed efficient Medicare Part B billing processes, reducing submission times by 11 days, resulting in $18 increased cash flow.
  • Reduced Medicare enrollment processing time by three years through the use of standardized forms and documentation templates.
  • Optimized Medicare compliance audits for 12 patients, saving the organization $17 in penalties.
  • Trained healthcare staff on Medicare billing compliance regulations, leading to a 72% reduction in claim denials.
  • Improved healthcare billing reconciliation processes, resolving disputes in under 6 months, and achieving a 18% resolution rate.
  • Led successful pilot program implementing Power BI for real-time tracking of service authorizations, reducing errors by 76%.
  • Improved overall service authorization management for Medicare patients by 67% by integrating Power BI.

Affiliations

  • Member of the Dual Eligible Special Needs Plans (D-SNP) Alliance, to better coordinate care for dual-eligible populations.
  • Association for Computing Machinery
  • Toastmasters
  • National Association for Home Care & Hospice (NAHC) - Special focus on Medicare compliance audits and funding models.
  • Regular attendee of state-level Medicare advisory committees, keeping up-to-date with regional regulatory shifts and Medicare procedures.
  • Association of Information Technology Professionals
  • American Marketing Association
  • Society of Women Engineers
  • Participation in the National Institutes of Health (NIH) Medicare research forums, advancing knowledge on patient-specific insurance outcomes.
  • International Association of Administrative Professionals

Certifications

  • Healthcare Compliance Certification - Brightline
  • Certified in Healthcare Compliance (CHC) Brightline
  • CompTIA Network+
  • Certified Professional Biller (CPB) - program
  • Certified Healthcare Financial Professional (CHFP) - Seattle
  • Certified Public Accountant (CPA)
  • Certified Medical Reimbursement Specialist (CMRS) - 2017
  • Medicaid Eligibility Certification - Ironclad Systems
  • Google Certified Professional Cloud Architect
  • Certified Public Accountant

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