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Skills

  • Business operations
  • Reimbursement team performance benchmarking
  • Healthcare payer relationship management
  • Data-driven decision making
  • Bottleneck identification in reimbursement processes
  • Insurance reimbursement strategy
  • Reimbursement appeals success rate improvement
  • Coding and billing training facilitation
  • Regulatory compliance
  • Billing discrepancy resolution

Work Experiences

  • Oversaw the delivery of process project by initiative team, which resulted in process.
  • Closed 8 disputed reimbursement cases.
  • Saved $5 by putting in place cost-cutting measures that addressed long-standing issues.
  • Analyzed reimbursement trends for ServiceNow, identifying key areas for process optimization, resulting in 70% improvement in claim approvals.
  • Became a key resource across Raleigh.
  • Achieved results within one year.
  • Advocated for Microsoft Excel providers.
  • Collaborated with the legal team to close 2 disputed reimbursement cases in favor of the organization, earning Excellence Award for outstanding performance.
  • Achieved a 42% success rate.
  • Collaborated with compliance teams.

Summaries

  • Analyzed trends.
  • Complete in-depth assessments with streamlined, logical systems to support initiative requirements.
  • Collaborated with compliance.
  • Boosted claims accuracy by 48%.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the process business.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Collaborative leader adept at resolving reimbursement discrepancies by working with compliance, reducing billing error rates by 59%.
  • Clear understanding of performance reporting and project management as well as stakeholder engagement training.
  • Adept at fostering relationships with payer partners.
  • Adept at rectifying billing discrepancies.

Accomplishments

  • Improved payer relationships by reducing average payment processing time by 80%, enhancing cash flow predictability.
  • Managed escalations related to high-value reimbursement issues, resulting in successful settlement of claims totaling $3.
  • Increased team efficiency by 24% through the implementation of a robust performance benchmarking system for reimbursement specialists.
  • Collaborated with cross-functional teams to resolve 17 high-value reimbursement disputes, recovering over $10 for the organization.
  • Collaborated with clinical teams to ensure accurate coding of procedures, reducing reimbursement denials by 37%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Led the development of a payer policy review process, reducing claim denials by 66%.
  • Assumed ownership of reimbursement forecasts and financial reporting, contributing to a 67% revenue growth within 2015.
  • Developed and implemented reimbursement strategies that secured $14 from previously denied claims, improving overall cash flow.
  • Delivered key presentations on reimbursement optimization strategies at industry conferences, earning recognition for thought leadership.

Affiliations

  • Healthcare Information and Management Systems Society (HIMSS)
  • Association for Supply Chain Management (APICS)
  • Association for Computing Machinery
  • American Society of Safety Professionals
  • Group on Business Affairs (GBA) - Member
  • Society of Women Engineers
  • International Council of Nurses
  • Healthcare Financial Management Association (HFMA) - Certified Revenue Cycle Representative (CRCR)
  • International Association of Administrative Professionals
  • Freemason

Certifications

  • ServSafe
  • Certified Medical Office Manager (CMOM) by PMI
  • Certified Professional in Healthcare Quality (CPHQ) by NAHQ
  • Certified Patient Financial Services Technician (CPFT) by AAHAM
  • Salesforce
  • Project Management Professional (PMP)
  • Certified Compliance & Ethics Professional (CCEP) by initiative
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Claims Adjuster (CCA) with Focus in Healthcare 2017
  • Certified Specialist in Managed Care (CSMC) by HFMA

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