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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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