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Skills

  • Problem resolution
  • Cross-functional team collaboration
  • Healthcare Software Implementation
  • Power BI Rollout and Training
  • Claims Rejection Prevention
  • Medical record review
  • Workflow Optimization
  • Conflict resolution
  • Escalation management
  • Auditing experience

Work Experiences

  • Achieved a 44% reduction in delayed requests.
  • Maintained my cool in stressful situations such as confrontations, interviews, and record searches.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Collaborated with the appeals team.
  • Created standardized workflow templates for pre-certification documentation, lowering processing time by 10 minutes per case.
  • Collaborated with clinical and administrative teams.
  • Achieved Employee of the Year in 2021.
  • Saved $5 by putting in place cost-cutting measures that addressed long-standing issues.
  • Updated investigation strategies to reflect current information after reviewing vendor management laws.
  • Developed a pre-certification tracking system.

Summaries

  • Exceptional at providing litigation support and maintaining meticulous records.
  • Achieved 48% department-wide error reduction.
  • Collaborated between clinical teams and billing departments.
  • Collaborator between clinical teams and billing departments to ensure alignment between approvals and coverage policies, decreasing claims rejections by 43%.
  • Achieved 15% approval on first submission.
  • Pre-Certification Coordinator with 5 years of experience in risk assessment is qualified.
  • 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.
  • With training in investigation and interview tactics, he is an expert in process compliance regulations.
  • Collaborative Pre-Certification Coordinator, known for working cross-departmentally to improve communication and eliminate bottlenecks, achieving an increase of 16% in accurate submissions.
  • Accomplished healthcare professional.

Accomplishments

  • Worked in tandem with patient registration and intake departments to confirm eligibility prior to submission, reducing processing delays by 42%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Communicated regularly with healthcare providers to obtain necessary documentation for pre-certification, decreasing claim denial rates by 38%.
  • Partnered with billing services to resolve insurance coverage issues, leading to a 80% increase in successful reimbursement claims.
  • Led automation of pre-certification submission process using Adobe Creative Suite, which reduced manual data entry time by 72%.
  • Streamlined communication between clinical and administrative departments, cutting average review times for pre-certifications by 65%.
  • Interpreted clinical guidelines to ensure pre-certifications met all payer policy requirements, contributing to a reduction in rejections by 55%.
  • Strengthened relationships with payers through consistent communication, leading to a 25% improvement in pre-certification approval rates.
  • Collaborated with team of 14 in the development of initiative.
  • Analyzed monthly pre-certification rejection reports and collaborated with the team on implementing corrective actions, reducing overall errors by 69%.

Affiliations

  • National Managed Healthcare Congress (NMHC)
  • Association for Computing Machinery
  • Accreditation Association for Ambulatory Health Care (AAAHC)
  • American Marketing Association
  • Utilization Review Accreditation Commission (URAC)
  • National Board for Certification of Hospice and Palliative Nurses (NBCHPN)
  • National Association of Social Workers
  • International Association of Administrative Professionals
  • National Association of Medical Staff Services (NAMSS)
  • Association of Clinical Research Professionals (ACRP)

Certifications

  • Medical Office Administration Certification initiative
  • Cisco Certified Network Associate (CCNA)
  • Certified Revenue Cycle Specialist (CRCS) – American Association of Healthcare Administrative Management (AAHAM)
  • CompTIA A+ Technician
  • Certified Public Accountant (CPA)
  • Certified Medical Billing Specialist (CMBS) - system
  • ServSafe
  • Healthcare Information and Management Systems Certification (CAHIMS) metric
  • Certified Documentation Improvement Practitioner (CDIP) - standard
  • Certified Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality (NAHQ)

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