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Skills

  • Managed care contract negotiation
  • Healthcare cost containment strategies
  • Corrective action planning for compliance issues
  • Communication of complex financial data to non-technical stakeholders
  • Stakeholder relationship management
  • Accounting remittances
  • Billing error resolution
  • Data-Driven Problem Solving
  • Healthcare claims denial appeals
  • Automated coding compliance implementation

Work Experiences

  • Aligned revenue integrity procedures with regulatory changes.
  • Collaborated with cross-functional teams to develop strategies that improved revenue cycle workflows and reduced denials by 16%.
  • Achieved a 23% decrease in claim denials.
  • Designed charge review protocols for the sales division.
  • Achieved a 12-day reduction in claims rework.
  • Achieved results over 11 months.
  • Analyzed revenue data trends to identify gaps in clinical documentation, leading to the implementation of best practices that resulted in 7% fewer denials.
  • Developed and implemented compliance education programs for 11 clinical departments ensuring adherence to CMS regulations, reducing audit citations by 84%.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Completed the project within 15 months.

Summaries

  • Adept at standard auditing procedures.
  • Analyst adept at minimizing revenue leakage through effective charge reconciliation procedures and proactive collaboration with clinical teams to prevent losses exceeding $6.
  • Revenue Integrity Analyst is a detail-oriented Revenue Integrity Analyst with 8 years of finance and accounting experience.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Hardworking and effervescent, with a strong desire for precision and efficiency.
  • Dedicated to increasing profits, lowering accounting errors, and streamlining accounting processes.
  • Focused, committed, and adept at quickly identifying errors and mitigating losses.
  • To ensure payment accuracy, be familiar with verifying information in the accounting ledger against vendor information.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Accounting systems and related computer software programs, such as HubSpot and Tableau, are second nature to me.

Accomplishments

  • Designed and standardized charge review protocols for the sales division, increasing billing efficiency by 53%, resulting in streamlined revenue recognition.
  • Led a departmental audit of high-cost procedures, identifying inefficiencies and recovering $6 in lost revenue within 18 months.
  • Developed and implemented a charge description master (CDM) audit system, leading to 80% fewer errors during claim submissions.
  • Enhanced payer communication processes, leading to faster resolution of underpaid claims and resulting in $15 recovered in underpayments within the past year.
  • Reviewed and optimized managed care contract terms, negotiating more favorable reimbursement rates, which increased annual revenue by $6.
  • Managed high-volume claim audits for the standard department, identifying an opportunity to recover $14 in missing revenue across two years.
  • Participated in the successful transition to ICD-system, ensuring operations maintained compliance while preventing revenue loss during the transition period.
  • Re-engineered workflow processes for patient billing and collections, reducing outstanding receivables by 37% and decreasing days in accounts receivable by 6 days.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Audited payer contract performance, identifying underpayments and inconsistencies, leading to regulatory updates and a 22% increase in collections.

Affiliations

  • Association of Information Technology Professionals
  • Society of Human Resource Management
  • Revenue Integrity Advisory Board for Portland or Northwind
  • Society of Women Engineers
  • Certified Revenue Cycle Professional (CRCP) Certification Program
  • National Association for Healthcare Quality (NAHQ)
  • Advisory Board Member, Healthcare Billing Reform Initiatives
  • Financial and Insurance Appeals Specialist Association
  • National Association of Healthcare Revenue Integrity (NAHRI)
  • Certified Professional Compliance Officer (CPCO)

Certifications

  • Certified Billing and Coding Specialist (CBCS) by NHA
  • CompTIA Network+
  • Certified Public Accountant
  • Certified in Healthcare Compliance (CHC) by the HCCA
  • Certified Medical Coding Auditor (CMCA-E/M)
  • Certified Health Data Analyst (CHDA)
  • Salesforce
  • Lean Six Sigma Certification system
  • Certified Professional in Healthcare Quality (CPHQ)
  • Epic Tapestry Certification 2024

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