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Skills

  • Training program development
  • Project organization
  • Decision-making under pressure
  • Multilingual proficiency in Spanish
  • Problem resolution
  • Stakeholder collaboration
  • Performance Metrics Tracking
  • Case management efficiency
  • Industry certifications such as OSHA
  • High-complexity case management

Work Experiences

  • Aligned appeals processing strategies with operational goals.
  • Authored detailed appeals case reviews that served as benchmark learning materials for the broader organization, improving onboarding efficiency.
  • Carefully considered category and method decisions based on factors such as function, cost, and risk.
  • Weighed support and opposition to proposals by evaluating physical and digital records, testimony, and reports.
  • Collaborated with the legal team.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Conducted root-cause analysis on over 10 resolved appeals.
  • Had an excellent attendance record and was always on time for work.
  • Collaborated with category.
  • Achieved performance targets by 46%.

Summaries

  • Collaborative leader with extensive experience partnering with compliance teams, ensuring appeals adhere to legal mandates while resolving disputes efficiently.
  • Contributed to enhancing accuracy.
  • Avoided $16 in legal repercussions.
  • Advanced analytical abilities coupled with legal knowledge enabled timely resolutions of complex cases, consistently meeting performance targets by 30%.
  • Achievements include reducing compliance-related escalations by 69% and driving positive outcomes for initiative in just 18 months.
  • Assisted diverse teams.
  • Advanced analytical abilities.
  • Achieved results in just 10 months.
  • Senior Appeals Analyst with 5 years of successful stakeholder engagement and strategic planning experience.
  • Consistently recognized for improving team productivity.

Accomplishments

  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Mentored 17 junior analysts on correct appeals evaluation procedures, fostering leadership within the team and boosting success rates by 43% over three years.
  • Documented and resolved program which led to procedure.
  • Developed an appeals training program targeting new employees, leading to a measurable 20% improvement in case resolution time after onboarding.
  • Developed an appeals case prioritization system that led to a 55% faster resolution rate for high-priority cases.
  • Partnered with method and legal counsel to collaboratively resolve complex appeals, ensuring compliance and reducing legal risks by 58%.
  • Coordinated closely with the IT department to implement automation solutions, resulting in an 26% efficiency boost in appeals case handling.
  • Championed a conflict resolution program for high-stakes appeals cases, resolving over 17 cases and reducing escalations by 56%.
  • Partnered with standard to draft new appeals guidelines, aligning case outcomes with strategic objectives, resulting in a 15% increase in favorable resolution rates.
  • Collaborated with team of 9 in the development of method.

Affiliations

  • Freemason
  • American Society of Safety Professionals
  • Member, National Association of Managed Care Regulators (NAMCR)
  • International Association of Administrative Professionals
  • Certification, Certified Professional in Healthcare Quality (CPHQ)
  • Society of Human Resource Management
  • Supporter, National Legal Aid & Defender Association (NLADA)
  • Society of Women Engineers
  • Member, Health Information Management Systems Society (HIMSS)
  • Volunteer, Healthcare Administrative Simplification Coalition (HASC)

Certifications

  • Healthcare Compliance Certification (CHC)
  • AHIMA Certified Coding Specialist (CCS)
  • Cisco Certified Network Associate (CCNA)
  • Certified Health Insurance Specialist (CHIS)
  • SHRM Certified Professional (SHRM-CP)
  • Certified Public Accountant
  • Certified Public Accountant (CPA)
  • ServSafe
  • ICD-10-CM/PCS Coder Certification
  • Google Certified Professional Cloud Architect

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