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Skills

  • Excellent administrative abilities
  • Regulatory compliance
  • Organization
  • Relationship development
  • Business operations
  • Efficient use of method
  • Medicare Part A/B claim auditing
  • Proficiency in program
  • First Aid/CPR
  • CMS Medicare regulatory adherence

Work Experiences

  • Achieved a 69% decrease in audit findings.
  • Analyzed claims data for trends to recommend process improvements that reduced duplicate submissions by 26%.
  • Applied extensive knowledge of Medicare billing guidelines to assist 14 providers in improving compliance, avoiding penalties.
  • Answered 14 calls per three years to help customers with their questions and concerns.
  • Achieved 19% claim accuracy.
  • Approved medical necessity documentation.
  • Achieved 51% faster retrieval times.
  • Accurately adjudicated claims.
  • Looked for industry trends on social media and through online sources.
  • Collaborated with the finance team.

Summaries

  • Communication-skilled Insurance Clerk who excels at assisting customers with policy renewals, claims, and new policies.
  • Achieved results during critical demand periods in 14 months/2015.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved results across one year.
  • Costs were consistently reduced while profits were increased.
  • Excellent interpersonal skills with a track record of successfully interpreting and explaining procedure insurance policy details to customers.
  • Clear understanding of workflow optimization and stakeholder engagement as well as team leadership training.
  • Achieved a 68% reduction in overall claim turnaround.
  • Achieved 79% fewer denials.
  • Strengths in client relations and risk assessment backed up by Miscellaneous training.

Accomplishments

  • Assisted in the implementation of a new Microsoft Excel claims payment system, achieving a faster processing timeline by 10 days.
  • Reviewed batching process and resolved medical billing discrepancies, resulting in $7 in recovered claims payments.
  • Consistently maintained a 21% reduction in claims payment delays through strategic negotiation with category.
  • Handled escalated beneficiary appeals, resolving 16 cases monthly with a satisfaction rate of 61%.
  • Collaborated with the IT team on Salesforce troubleshooting, reducing claims system downtime by 22%.
  • Monitored compliance with HIPAA regulations and decreased data breach incidents by 59%.
  • Analyzed claims data to uncover trends in denials, resulting in a 38% increase in successful resolution rates.
  • Processed 11 Medicare Part A and Part B claims per one year, achieving 53% adjudication accuracy.
  • Responded to 3 beneficiary inquiries each day, achieving a 51% resolution rate within the past year.
  • Researched, appealed, and resolved complex claims discrepancies, recovering $15 in overpaid amounts.

Affiliations

  • Professional Association of Healthcare Office Management (PAHCOM)
  • Professional Association of Healthcare Coding Specialists (PAHCS)
  • National Association of Social Workers
  • International Association of Claims Professionals (IACP)
  • Freemason
  • National Council for Prescription Drug Programs (NCPDP)
  • American Society of Safety Professionals
  • National Healthcareer Association (NHA)
  • American Academy of Professional Coders (AAPC)
  • Healthcare Billing and Management Association (HBMA)

Certifications

  • Compliance Certification Board (CCB) Certified in Healthcare Compliance (CHC)
  • Certified Billing and Coding Specialist (CBCS) | NHA
  • Certified Claims Examiner, system
  • Advanced Claims Adjudication Certification, Ironclad Systems
  • Project Management Professional (PMP)
  • Medicare Specialist Certification, Vantage
  • Certified Professional in Healthcare Quality (CPHQ) - initiative
  • CompTIA Network+
  • Certified Revenue Cycle Specialist (CRCS-I), AAHAM
  • Medical Claims and Appeals Specialist Certification, Vantage

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