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Skills

  • Cross-functional collaboration
  • Project organization
  • Problem resolution
  • Business operations
  • Team management
  • Automated verification tool implementation
  • Organization
  • Claims Denial Reduction Strategies
  • Insurance provider relationship management
  • First Aid/CPR

Work Experiences

  • Collaborated with method customers to determine their needs and deliver category service.
  • Boosted overall approval rate by 16%.
  • Collaborated with cross-functional teams, including billing and scheduling departments, to streamline workflows, reducing patient wait times by 31%.
  • Graded items and assigned quality levels, rejection status, and acceptance status.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Collaborated with sales to ensure staff adhered to insurance provider requirements.
  • Analyzed trends in insurance denials and provided actionable insights to management, leading to a 84% increase in overall pre-certification success rates.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Answered 3 calls per 18 months to help customers with their questions and concerns.
  • Coordinated with system partners to finalize designs and confirm requirements.

Summaries

  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • When performing tasks such as standard testing and keeping detailed records of actions, a proven history of reliability is demonstrated.
  • In client relations and workflow optimization, dedicated analysis and well-developed skills are required.
  • Determined team player with a track record of identifying and tracking critical issues.
  • Collaborated across billing and scheduling departments.
  • Costs were consistently reduced while profits were increased.
  • Within Miscellaneous, senior Pre-Certification Specialist and outstanding performer in strategic planning and performance reporting.
  • Pre-Certification Specialist with 12 years of experience in program organization.
  • Fully compliant with all safety procedures and rules.
  • Achieved a 67% decrease in patient complaints.

Accomplishments

  • Coordinated with billing department to fully comply with initiative criteria, resulting in a 80% increase in claim approval rates.
  • Coordinated with healthcare providers to verify medical necessity, improving accuracy for pre-approved treatments and reducing denials by 80%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Trained 8 team members on insurance verification processes, resulting in a 76% decrease in processing times.
  • Proactively coordinated between method to clear outstanding pre-certification requests, contributing to a 73% increase in departmental efficiency.
  • Audited pre-certification requests for standard, reducing denial risk and improving turnaround time by 74%.
  • Point person for handling urgent medical procedure authorizations, cutting down the approval times from 11 days to 14 days.
  • Optimized denial management by auditing 11 denied claims monthly, reversing 66% of prior rejections.
  • Reduced patient complaints by 59% by educating stakeholders on insurance and authorization expectations and timelines.
  • Led the initiative to integrate HIPAA-compliant pre-certification practices, ensuring full regulatory compliance in 2015.

Affiliations

  • Patient Advocacy Alliance Chicago
  • Compliance and Audit Management Society Columbus
  • American Medical Informatics Association
  • Insurance Pre-Authorization Task Force Seattle
  • Medical Group Management Association (MGMA)
  • Health Care Compliance Association (HCCA)
  • American Health Information Management Association (AHIMA)
  • International Association of Administrative Professionals
  • Certified Specialist in Healthcare Access Management (CSHAM)
  • Association of Information Technology Professionals

Certifications

  • Insurance Verification Specialist Certification
  • Cisco Certified Internetwork Expert (CCIE)
  • Patient Access Certification (PAC) through NAHAM
  • Certified Professional Coder (CPC) through AAPC
  • Certified Coding Specialist (CCS) through AHIMA
  • Approved Certified Healthcare Insurance Specialist (ACHIS)
  • Certified Appeals Professional (CAP)
  • Certified in Medical Billing and Coding Technologies (CMBCT)
  • Certified Coding Associate (CCA) - procedure
  • Certified Public Accountant

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