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Skills

  • Supervision
  • Client consultation
  • Complex claims resolution
  • Health Plan Enrollment Metrics
  • Proficiency in ServiceNow
  • Regulatory compliance
  • Medicare Appeals Management
  • Appointment scheduling
  • First Aid/CPR
  • Process improvement

Work Experiences

  • Achieved a 33% improvement in Net Promoter Score (NPS).
  • Achieved an average processing time of 5 days ahead of deadlines.
  • Analyzed success of Medicare Special Enrollment Period (SEP) outreach campaigns, implementing insights that improved participation by 44%.
  • Sorted jobs that were relevant to candidates' interests and forwarded the information to them.
  • Analyzed data from interviews, educational and medical records, consultations with other professionals, and diagnostic evaluations to determine clients' capabilities, needs, and eligibility for services.
  • Achieved a 78% increase in customer satisfaction.
  • Communicated with people from various cultures and backgrounds during the application process.
  • Achieved a streamlined claim process.
  • Analyzed success of Medicare SEP outreach campaigns.
  • Achieved resolution within 48 hours.

Summaries

  • Assisted clients in comparing and selecting high-value Medicare plans.
  • Considered a team player who excels at multitasking.
  • Achieved over $11 in new enrollments.
  • Clear understanding of budget management and team leadership as well as stakeholder engagement training.
  • Motivated professional capable of managing and monitoring member and group eligibility information.
  • Dedicated to expanding job opportunities by forging strong bonds with employers and job seekers.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the method business.
  • Boosted client understanding and satisfaction.
  • Adept at translating complex Medicare regulations.
  • Achieved 18 new enrollments.

Accomplishments

  • Utilized data analytics tools to examine trends in Medicare claims denials, recommending process improvements that increased acceptance rates by 62%.
  • Trained over 2 staff on Medicare claim submission best practices, leading to an increase in claim accuracy by 74%.
  • Resolved 11 client escalations regarding Medicare coverage issues, achieving a 71% customer satisfaction increase.
  • Assisted in the Medicare enrollment of dual-eligibility patients, expediting coverage approvals by 52% at the Atlanta facility.
  • Developed Medicare enrollment strategies that resulted in 82% increase in new enrollments for 2019.
  • Implemented a Medicare compliance review process, lowering audit discrepancies by 58% for 2017.
  • Developed cross-functional communication protocols for Medicare claims, improving inter-department collaboration and claim resolution rates by 44%.
  • Led a Medicare reimbursement project that reduced outstanding claims by 15 in the past year.
  • Proactively identified errors in Medicare claims submissions, reducing denial rates by 50% over one year.
  • Created and led workshops on Medicare billing procedures, boosting claim acceptance rates by 59% for marketing.

Affiliations

  • National Alliance on Mental Illness (NAMI) for Medicare casework focus
  • National Committee for Quality Assurance (NCQA)
  • Association of Health Care Office Management (AHCOM)
  • American Health Information Management Association (AHIMA)
  • Rotary International
  • Certified Professional in Health Care Risk Management (CPHRM) by Beacon Labs
  • National Association of Health Underwriters (NAHU)
  • Certified in Healthcare Compliance (CHC) by process
  • Lions Club
  • American Hospital Association (AHA)

Certifications

  • SHRM Senior Certified Professional (SHRM-SCP)
  • Healthcare Compliance Certification Program (HCCP)
  • Salesforce
  • Medicaid and Medicare Certified Administrator (MMCA)
  • National Healthcareer Association (NHA) Certified Billing and Coding Specialist (CBCS)
  • Certified Healthcare Access Associate (CHAA) by NAHAM
  • Apple Certified Associate (ACA)
  • Certified Medical Office Manager (CMOM)
  • Certified Health Data Analyst (CHDA) by AHIMA
  • Cisco Certified Internetwork Expert (CCIE)

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