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Skills

  • Regulatory compliance
  • Training program development
  • Workflow Optimization
  • Business operations
  • Vulnerability examination
  • First Aid/CPR
  • Insurance Payer Communication
  • Initial Submission Approval Processes
  • Cost-saving strategies
  • Problem resolution

Work Experiences

  • Analyzed pre-certification discrepancies.
  • Collaborated with the IT department to automate pre-certification requests, reducing approval times by 15% and manual errors by 43% in 2023.
  • Automated pre-certification requests.
  • Coordinated with billing departments to ensure pre-certification approvals aligned with coverage policies, lowering claim rejections by 59%.
  • Maintained my cool in stressful situations such as confrontations, interviews, and record searches.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Developed a pre-certification tracking system.
  • Collaborated with clinical and administrative teams.
  • Conducted market analysis on pre-certification trends for Salesforce, leading to strategic adjustments in workflow that boosted approval rates by 6%.
  • Achieved 17% improvement in interdepartmental communication.

Summaries

  • Achieved 15% approval on first submission.
  • Achieved a 45% reduction in user-related errors.
  • Addressed diverse patient needs.
  • Collaborator between clinical teams and billing departments to ensure alignment between approvals and coverage policies, decreasing claims rejections by 43%.
  • Achieved savings worth over $13 annually.
  • Accomplished healthcare professional with extensive experience in pre-certification system analysis and insurance verification, improving process efficiency and approval turnaround by 16 days.
  • Consistently achieved accurate approvals.
  • Balanced high-volume requests.
  • Collaborative Pre-Certification Coordinator, known for working cross-departmentally to improve communication and eliminate bottlenecks, achieving an increase of 16% in accurate submissions.
  • Capable of leading cross-functional teams in optimizing pre-certification workflows, saving $11 annually, and improving case approval rates by 58%. Collaborative and results-focused.

Accomplishments

  • Monitored pre-authorization denials and worked with medical providers to obtain approval for 18 high-priority cases, overcoming coverage challenges.
  • Collaborated with the billing department to review and correct incomplete submissions, reducing denied claims by 70%.
  • Analyzed monthly pre-certification rejection reports and collaborated with the team on implementing corrective actions, reducing overall errors by 69%.
  • Effectively utilized patient health information databases, improving the accuracy of pre-certifications through better access to medical documentation.
  • Proactively identified opportunities to streamline communication between payer and provider organizations, increasing first-time approval rates by 66%.
  • Helped facilitate physician training regarding insurance requirements for specific treatments, enhancing the speed of pre-certification submissions by 26%.
  • Identified and addressed discrepancies in insurance verification, reducing denial rates by 42%.
  • Interpreted clinical guidelines to ensure pre-certifications met all payer policy requirements, contributing to a reduction in rejections by 55%.
  • Communicated regularly with healthcare providers to obtain necessary documentation for pre-certification, decreasing claim denial rates by 38%.
  • Optimized the pre-certification workflow by integrating Workday, decreasing overall request turnaround time by 63%.

Affiliations

  • Toastmasters
  • Utilization Review Accreditation Commission (URAC)
  • Association for Supply Chain Management (APICS)
  • Health Care Compliance Association (HCCA)
  • National Case Management Network (NCMN)
  • Society for Healthcare Consumer Advocacy (SHCA)
  • Lions Club
  • American Association of Professional Coders (AAPC)
  • Medical Insurance Verification Association (MIVA)
  • Jaycees

Certifications

  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Professional in Patient Safety (CPPS) - Institute for Healthcare Improvement (IHI)
  • SHRM Certified Professional (SHRM-CP)
  • Lean Six Sigma Green Belt Healthcare Certification initiative
  • Certified Healthcare Privacy and Security (CHPS) - initiative
  • Insurer and Payer Authorization Specialist Certification process
  • Google Certified Professional Cloud Architect
  • Patient Access Specialist Certification method
  • Healthcare Access Associate (CHAA) framework
  • Revenue Cycle Specialist Certificate system

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