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Skills

  • Key holder experience
  • International sales support
  • Order fulfillment
  • Route dispatch
  • Medical billing and coding
  • Claim software proficiency (system)
  • Data entry
  • Claim trend analysis
  • Process improvement strategies
  • Training development aptitude

Work Experiences

  • Increased the team's revenue by over $17 in sales.
  • Backorder availability, future inventory, and special orders were all discussed with vendors.
  • Recommended, selected, and assisted in locating and obtaining out-of-stock product based on customer requests.
  • Built strong, compassionate client relationships and earned a reputation for exceeding service standards.
  • Kept track of cash drawers in multiple checkout stations and ensured that there was enough cash on hand.
  • Looked into and resolved issues with accounting, service, and delivery.
  • Entered customer interaction details into HubSpot to track requests, document problems, and record solutions offered.
  • Established long-term, loyal customer relationships by providing excellent service and detailed order, account, and service information.
  • Collaborated with vendors to plan more than 8 daily pickups and weekly deliveries.
  • Followed through on all critical inter-departmental escalations to increase customer retention rates.

Summaries

  • Customer Service Representative with exceptional oral and written communication, active listening, and problem-solving abilities.
  • Clear understanding of project management and performance reporting as well as project management training.
  • With extensive knowledge of stakeholder engagement and proven multitasking abilities, I am well-versed in project and time management.
  • Provider Claim Resolution Specialist proactive with experience in providing support and resolving customer complaints.
  • Customer service specialist with over 12 years of experience resolving account and service issues for Miscellaneous clients.
  • Very knowledgeable about Asana, as well as standard competitors and offerings.
  • Fluent in Japanese. Personable and professional communicator.
  • Service-oriented team player with a track record of providing high-quality support in the Miscellaneous for 17 years.
  • Upbeat and vivacious, with grace in dealing with adversity via resourcefulness and adaptability.
  • Within Miscellaneous, senior Provider Claim Resolution Specialist and outstanding performer in project management and performance reporting.

Accomplishments

  • Supported multiple providers with claim data entry issues, which led to a 49% decrease in resubmissions and delays.
  • Provided root cause analysis for recurring claim resolution issues, reducing claim rework by 51% over the course of 2018.
  • Worked closely with the IT department to fix performance issues in claims management software, resulting in system downtime being reduced by 18% hours.
  • Developed and managed an Excel-based claims tracker that improved claim follow-up time by 73% company-wide.
  • Collaborated with IT to enhance report extraction capabilities, improving claims data visibility by 8%.
  • Collaborated with cross-functional teams, including finance and operations, to expedite payment of high-priority claims worth over $5.
  • Achieved a 44% decrease in claim rejection rates through vigilant provider outreach and claim data validation.
  • Served as the primary point of escalation for high-dollar claims, successfully recovering $17 within 2 days.
  • Utilized workflow automation tools to expedite claim processes, reducing overall resolution times by 3 days.
  • Spearheaded an initiative to standardize claim status updates, reducing time spent on follow-ups by 73%.

Affiliations

  • Provider Claims and Billing Professionals Network
  • Physician-Provider Claims Data Analysts Alliance
  • American Association of Healthcare Administrative Management (AAHAM)
  • Member, National Association for Healthcare Quality (NAHQ)
  • Fellow, Healthcare Financial Management Association (FHFMA)
  • American Association of Medical Audit Specialists (AAMAS)
  • Member, Risk Management Society (RIMS)
  • Healthcare Claims Integrity Coalition (HCIC)
  • International Council of Nurses
  • Certified Specialist in Managed Care (CSMC)

Certifications

  • Healthcare Fraud Prevention & Detection Certification, Meridian
  • Microsoft Certified Systems Engineer (MCSE)
  • Health Data Analyst (CHDA) Certification, program
  • Certified Professional in Healthcare Quality (CPHQ) - Vantage
  • Healthcare Claims Management Certification, category
  • Certified Coding Specialist (CCS) by American Health Information Management Association (AHIMA)
  • Salesforce
  • ICD-10-CM Mastery Certificate, Lakeside Partners
  • Certified Managed Care Professional (CMCP) – Northwind
  • SHRM Senior Certified Professional (SHRM-SCP)

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