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Skills

  • Automated verification tool implementation
  • Process improvement
  • Supervision
  • Team management
  • Knowledge of billing and coding software
  • Medical Documentation Review
  • Cross-functional collaboration
  • Customer service
  • Issue resolution
  • Patient complaint resolution

Work Experiences

  • Collaborated with sales to ensure staff adhered to insurance provider requirements.
  • Graded items and assigned quality levels, rejection status, and acceptance status.
  • Achieved a 13% reduction in expired pre-authorizations.
  • Analyzed trends in insurance denials and provided actionable insights to management, leading to a 84% increase in overall pre-certification success rates.
  • Coordinated with system partners to finalize designs and confirm requirements.
  • Transported Salesforce to two years customer locations.
  • Achieved a 40% increase in pre-certification success rates.
  • Achieved a 80% increase in approval rates.
  • Assessed and processed over 14 pre-certification requests monthly, driving a 27% reduction in turnaround time while maintaining a 29% error-free rate.
  • Collaborated with billing teams.

Summaries

  • Highly detailed with a long history of catching minor flaws that others would overlook.
  • Expert in the use of specialized tools and instruments to test products.
  • Adept at building strong relationships with insurance providers to expedite pre-authorizations, ensuring approvals within 17 business days and saving organizations up to $2 annually.
  • Aiming to reduce denial rates.
  • Pre-Certification Specialist with 10 years of successful risk assessment and stakeholder engagement experience.
  • Achieved a 71% reduction in patient wait times.
  • Within Miscellaneous, senior Pre-Certification Specialist and outstanding performer in strategic planning and performance reporting.
  • Fully compliant with all safety procedures and rules.
  • Creates detailed reports, maintains records, and collaborates with management to resolve issues.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the category business.

Accomplishments

  • Monitored, tracked, and completed high-priority authorizations for 13 patients across one year, minimizing delays in their treatment.
  • Proactively identified and solved discrepancies between patient records and insurance requests, improving first-pass approval rates by 76%.
  • Point person for handling urgent medical procedure authorizations, cutting down the approval times from 11 days to 14 days.
  • Trained 8 team members on insurance verification processes, resulting in a 76% decrease in processing times.
  • Documented and resolved procedure which led to program.
  • Facilitated effective communication between patients, providers, and insurance companies, leading to a Outstanding Service Award for superior patient support.
  • Reduced appeals due to denied pre-authorizations by 63% through revision of internal documentation standards.
  • Reduced patient complaints by 59% by educating stakeholders on insurance and authorization expectations and timelines.
  • Reviewed pre-certification submissions for completeness, improving approval timeframes by 35% without sacrificing quality.
  • Collaborated with team of 16 in the development of system.

Affiliations

  • American Academy of Professional Coders (AAPC)
  • International Association of Administrative Professionals
  • Association for Training and Development in Healthcare (TDH)
  • American Medical Informatics Association
  • Certified Professional Biller (CPB) Certification
  • Toastmasters
  • Healthcare Billing and Management Association (HBMA)
  • Billing & Coding Certification (CBCS) Affiliation
  • Patient Chart Auditing Collaborative Chicago
  • Society of Women Engineers

Certifications

  • Certified Medical Reimbursement Specialist (CMRS)
  • Healthcare Compliance Certification (CHC) - Northwind
  • Certified Medical Insurance Specialist (CMIS)
  • Prior Authorization Certified Specialist (PACS) - PMI
  • Approved Certified Healthcare Insurance Specialist (ACHIS)
  • Medical Billing Certification (MBC) - Northwind
  • Certified Coding Specialist (CCS) through AHIMA
  • Health Information Technology Certified Professional (HITCP)
  • Certified Coding Associate (CCA) - procedure
  • CompTIA A+ Technician

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