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Skills

  • Team management
  • Insurance authorizations for high-cost procedures
  • Resource information
  • Documentation and paperwork
  • Insurance Verification
  • Customer service and patient handling
  • Medical coding and compliance (HIPAA)
  • Applicant engagement
  • Operational improvement
  • Claim denial prevention

Work Experiences

  • Used Jira and ServiceNow to keep track of the candidate files and notes for over 17 candidates.
  • Coded documents accurately.
  • Built relationships with local insurance representatives.
  • Clarified policy details.
  • Achieved a 37% increase in on-time pre-authorization submissions through meticulous tracking and follow-up efforts.
  • Achieved a 99% approval rate.
  • Aligned on common bottlenecks in the clearance process.
  • Collaborated with billing teams on corrective actions.
  • Championed a pilot program for using Adobe Creative Suite.
  • Analyzed clinical documents.

Summaries

  • Within Miscellaneous, senior Precertification Specialist and outstanding performer in stakeholder engagement and team leadership.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the program business.
  • Achieved 78% on-time submission rates.
  • 6 years of experience.
  • Collaborated with clinical and billing teams.
  • Professional who is well-organized and has excellent communication and multitasking skills.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Costs were consistently reduced while profits were increased.
  • Precertification Specialist with 3 years of successful stakeholder engagement and cross-functional collaboration experience.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.

Accomplishments

  • Collaborated with the coding and clinician teams to revamp authorization protocols, decreasing complex authorization denials by 47% in just 10 months.
  • Spearheaded a new initiative with the quality control team, reducing precertification denials by 70%.
  • Established specialized protocols for handling cases with common insurance providers that resulted in a 61% boost in approval speed.
  • Streamlined pre-certification workflows, which reduced processing times by 11 days and improved patient feedback scores by 50%.
  • Created an updated insurance verification checklist that resulted in a 37% reduction in denials across multiple specialties.
  • Facilitated communication between patients and insurance companies, contributing to better understanding and reducing patient complaints by 62%.
  • Engineered new workflows that enabled faster reimbursement processes, benefiting both hospital operations and patient care; reduced revenue loss by 49%.
  • Trained 8 new hires on insurance verification protocols, leading to a 60% improvement in first-time insurance approval rates.
  • Developed robust relationships with payer representatives that shortened the insurer response time from 9 days to 2 days regarding pre-certification decisions.
  • Worked with leadership on an early-warning system for anticipated payer changes, reducing forecasted pre-certification issues by 51% during transition periods.

Affiliations

  • Freemason
  • Cerner® PowerChart Certification
  • International Association of Administrative Professionals
  • National Association for Home Care & Hospice (NAHC)
  • American Marketing Association
  • Certified Healthcare Financial Professional (CHFP)
  • Precertification Specialist Certification by procedure
  • Association of Information Technology Professionals
  • National Association of Insurance Commissioners (NAIC)
  • Lions Club

Certifications

  • Certified Specialist in Managed Care (CSMC)
  • Certified Healthcare Financial Professional (CHFP)
  • First Aid/CPR Certified
  • Epic Certifications in Revenue Cycle Management - Adobe Creative Suite
  • Certified Prior Authorization Specialist (CPAS) - Harbor & Co.
  • Certified Medical Billing Specialist (CMBS) – Cedar Works
  • Salesforce
  • CompTIA Network+
  • Certified HIPAA Professional (CHP)
  • SHRM Certified Professional (SHRM-CP)

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