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Skills

  • Business analysis
  • Complex Case Negotiation
  • Inventory oversight
  • Goal-Oriented Leadership
  • Financial Management
  • Project management
  • Customer retention strategies
  • Training and mentoring
  • Cross-functional collaboration
  • Contract Management

Work Experiences

  • Authored comprehensive documentation on claims adjustment procedures, significantly improving ease of reference and adherence to protocols.
  • Was in charge of the team and set the overall vision.
  • Created training materials, task and process guidelines, and provided employees with clear and concise instructions.
  • Automated manual claims handling processes.
  • Authored comprehensive documentation on claims adjustment procedures.
  • Interviewed, hired, and trained new employees for the Supervisor, Health Claims position.
  • In charge of monitoring the workshop work flow for 2 employees.
  • Built, managed, and coached in-house and outsourced teams, implementing training programs to boost productivity and efficiency.
  • Achieved a 85% decrease in coding errors.
  • Investigated equipment failures using a variety of troubleshooting techniques.

Summaries

  • Employees are directed and motivated to meet challenging performance and quality goals.
  • Award-winning supervisor with 6 years of experience in a variety of roles in a fast-paced environment.
  • Concepts and best practice strategies in vendor management are second nature to me.
  • Contribute to continuous process improvement in order to achieve objectives.
  • A creative and motivated leader who excels at completing complex projects by combining exceptional design and planning skills.
  • Customer satisfaction is ensured by the lead manager and driving force.
  • Working as part of a team, bringing the necessary experience and knowledge to meet any operational need.
  • Perceptive, with a knack for spotting employee flaws and gently addressing them with constructive feedback.
  • Professional who is capable and forward-thinking, and who understands how to set goals that are aligned with the company's vision.
  • Approaches leadership in a methodical and thorough manner.

Accomplishments

  • Implemented a new claims evaluation system using Power BI, increasing claim processing capacity by 59% while maintaining quality standards.
  • Monitored changes in healthcare regulations, ensuring all processed claims adhered to new standards, minimizing risk to the company.
  • Utilized advanced claims processing software like Asana to improve adjudications efficiency by 74% and maintain compliance.
  • Supervised a claims portfolio valued at over 12, ensuring accurate risk assessments and timely resolutions.
  • Led a team of 5 health claims adjusters, ensuring timely and accurate processing of high-severity cases, resulting in a 15% reduction in claim backlog.
  • Successfully led team through the adoption of new claims adjudication software, improving overall productivity by 43%.
  • Created a peer review mechanism for claim evaluation, which reduced oversight issues and boosted file accuracy by 74%.
  • Successfully audited claims for compliance with HIPAA and ACA regulations, avoiding potential legal penalties and saving the company 12 in fines.
  • Played a critical role in negotiating settlements for high-exposure claims, minimizing potential company losses by 2.
  • Partnered with senior leadership to implement cost-containment strategies, saving 3 annually through more efficient claims settlements.

Affiliations

  • Certified Professional in Healthcare Quality (CPHQ)
  • Professional Insurance Agents (PIA)
  • Chartered Property Casualty Underwriter (CPCU) Society
  • Project Management Institute
  • American Medical Informatics Association
  • National Association of Social Workers
  • Institute of Health Insurance Management (IHIM)
  • American Health Information Management Association (AHIMA)
  • International Association of Claims Professionals (IACP)
  • American Society of Safety Professionals

Certifications

  • Certified Healthcare Financial Professional (CHFP)
  • Supervisory Skills Certificate in Insurance Claims - Vantage
  • Health Claims Examiner with Medical Transcription Certification
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Public Accountant
  • CompTIA A+ Technician
  • SHRM Certified Professional (SHRM-CP)
  • ICD-10-CM Coding Certification
  • Associate, Customer Service (ACS) - Cedar Works
  • Fellow, Life Management Institute (FLMI)

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