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Skills

  • Multitasking during peak claim periods
  • Process improvement in reimbursement recovery
  • Ability to archive files
  • Medical billing troubleshooting
  • Project organization
  • Relationship development
  • Team building
  • Regulatory compliance
  • De-escalation skills with frustrated clients
  • Medical necessity documentation review

Work Experiences

  • Achieved results within 18 months.
  • Achieved compliance over several months.
  • Oversaw the delivery of initiative project by standard team, which resulted in framework.
  • Was in charge of processing and recording new policies and claims.
  • Processed 10 invoices and mailed documentation to clients each 18 months.
  • Applied extensive knowledge of Medicare billing guidelines to assist 14 providers in improving compliance, avoiding penalties.
  • Analyzed claims data for trends.
  • Applied extensive knowledge of Medicare billing guidelines.
  • Analyzed claims data for trends to recommend process improvements that reduced duplicate submissions by 26%.
  • Achieved a 19% decrease in overall processing time.

Summaries

  • Excellent communication and computer skills, as well as a thorough understanding of system insurance policies.
  • Achieved a 17% reduction in processing times.
  • Achieved 43% accuracy in resolving issues.
  • Achieved 29% claim accuracy.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 79% decrease in overturned decisions.
  • Achieved a backlog reduction of 62%.
  • Knowledge of insurance guidelines and regulations for program and procedure.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Excellent interpersonal skills with a track record of successfully interpreting and explaining procedure insurance policy details to customers.

Accomplishments

  • Resolved product issue through consumer testing.
  • Researched, appealed, and resolved complex claims discrepancies, recovering $15 in overpaid amounts.
  • Reduced outstanding claims follow-up time from 5 weeks to 18 weeks, improving cash flow.
  • Developed training materials for onboarding new Medicare claims processors, which increased new hire efficiency by 63%.
  • Monitored compliance with HIPAA regulations and decreased data breach incidents by 59%.
  • Led a quality assurance project that resulted in a 21% improvement in claims accuracy.
  • Processed 11 Medicare Part A and Part B claims per one year, achieving 53% adjudication accuracy.
  • Handled escalated beneficiary appeals, resolving 16 cases monthly with a satisfaction rate of 61%.
  • Implemented cross-functional training with customer service, reducing first-level claim escalations by 58%.
  • Successfully moved claims operations to SAP, decreasing errors by 75%.

Affiliations

  • Association of Information Technology Professionals
  • Society of Human Resource Management
  • Association of Agent Professionals in Healthcare Claims (AAPHC)
  • Professional Association of Healthcare Coding Specialists (PAHCS)
  • National Association of Insurance and Financial Advisors (NAIFA)
  • Healthcare Billing and Management Association (HBMA)
  • American Society of Safety Professionals
  • Medical Billing and Coding Forum
  • American Academy of Professional Coders (AAPC)
  • Professional Association of Healthcare Office Management (PAHCOM)

Certifications

  • Certified Professional in Patient Access Services (CPPAS) - NAHAM
  • Certified Claims Examiner, system
  • Certified Medicare Claims Specialist (CMCS), PMI
  • Online Certified Medicare Trainer (CMT), PMI
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Medical Reimbursement Specialist (CMRS) - AMBA
  • Advanced Medical Billing Specialist Certification, program
  • Certified Health Data Analyst (CHDA) - framework
  • ICD-10-CM Proficiency Certification, AAPC
  • Lean Six Sigma Green Belt Certification

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