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Skills

  • Retro-Authorizations
  • Supervision
  • Patient scheduling
  • Customer service in healthcare
  • Advanced reporting skills
  • MS Office
  • Medical coding
  • Team management
  • Data-driven decision making
  • Team building

Work Experiences

  • Improved bill payment timeliness by developing flexible payment plans for patients.
  • Answered phone calls from members of the plan and medical staff inquiring about authorization details.
  • Awarded President's Club for successfully authorizing over 18 complex treatment plans annually, with less than 82% rejections.
  • Communicated efficiently with healthcare payers.
  • Requests for nonstandard services were escalated to framework personnel in project management.
  • Created and maintained spreadsheets that detailed all medical procedures, including any denials or approvals that were necessary.
  • Authorized over 3 complex treatment plans annually.
  • Assessed complex cases.
  • By maintaining a filing system for both in-house and discharged residents, I was able to facilitate organized record retrieval and access.
  • Wrote and distributed denial letters outlining the reasons for the denial as well as possible appeal options.

Summaries

  • Achieved a 74% reduction in authorization delays.
  • Healthcare practices, compliance standards, and operations are all familiar territory for this versatile administrative professional.
  • Patient outcomes and feedback from caregivers are meticulously tracked.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Maintain high-volume medical offices by coordinating files, appointments, and other patient needs efficiently.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 57% decrease in operational processing time.
  • Accomplished at managing high-stakes negotiations with insurers to secure approvals for cutting-edge treatments, resulting in a total of $17 in authorized coverage for high-cost therapies.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • With over 18 years of experience in the category industry, I am committed to organization and collaboration.

Accomplishments

  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Developed a comprehensive training program for new hires, reducing onboarding time by 53% and improving processing efficiency.
  • Collaborated with team of 18 in the development of framework.
  • Managed retrospective authorizations for treatments, ensuring compliance with payer-specific requirements and improving approval rates by 79%.
  • Successfully processed an average of 2 prior authorization requests weekly, achieving 59% approval rate.
  • Resolved product issue through consumer testing.
  • Partnered with compliance and legal teams to implement new protocols, ensuring 38% adherence to payer guidelines.
  • Streamlined internal workflows by integrating QuickBooks into authorization tracking, improving processing time by 82%.
  • Re-engineered the appeals submission process, increasing standardized document submissions that improved overall appeal success by 52% within 7 months.
  • Monitored and managed authorization requests for high-priority cases, ensuring timely approvals for over 18 urgent cases monthly.

Affiliations

  • American Society for Healthcare Engineering (ASHE)
  • Association of Information Technology Professionals
  • Quality Assurance and Performance Improvement (QAPI) Certification
  • American Health Information Management Association (AHIMA)
  • Society of Women Engineers
  • National Prior Authorization Program Association (NPAPA)
  • American College of Healthcare Executives (ACHE)
  • National Healthcareer Association (NHA)
  • International Federation of Health Plans (IFHP)
  • International Council of Nurses

Certifications

  • Certified Medication Therapy Management Specialist (CMTM) by NHA
  • ServSafe
  • Certified Public Accountant (CPA)
  • Certified Healthcare Access Manager (CHAM) by NAHAM
  • Certified Healthcare Access Associate (CHAA) by NAHAM
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Compliance & Ethics Professional (CCEP) by process
  • First Aid/CPR Certified
  • Certified Clinical Documentation Specialist (CCDS) by ACDIS
  • Insurance Billing & Coding Specialist Certification by system

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