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Skills

  • Project organization
  • Microsoft Excel Utilization Training
  • Decision Turnaround Optimization
  • Database administration
  • Problem resolution
  • Appeals Process Coordination
  • Business Administration
  • Audit Initiative Leadership
  • Regulatory compliance
  • Supervision

Work Experiences

  • Aligned documentation with contract compliance.
  • Assisted case managers in interpreting utilization guidelines.
  • Achieved 4% savings in healthcare costs.
  • By automating client correspondence, record tracking, and data communications, I was able to improve office operations.
  • Audited clinical case files for compliance.
  • Achieved a 18 reduction in penalties for noncompliance.
  • Assisted in long-term resource allocation.
  • Established and developed a highly efficient and dependable administrative team by providing ongoing coaching and motivation and fostering career advancement.
  • Effectively managed costs and billing, as well as financial discrepancies, by using system software to organize account information.
  • Completed 16 employees' bi-weekly payroll.

Summaries

  • Achieved a 77% improvement in denial handling.
  • Within Miscellaneous, senior Utilization Management Coordinator and outstanding performer in quality assurance and budget management.
  • Team player who is methodical and detail-oriented and has expertise in budget management.
  • Aided management in resource allocation.
  • Capable mediator.
  • Strengths in performance reporting and quality assurance backed up by Miscellaneous training.
  • Adept at coordinating high-stakes appeals processes.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 15% reduction in readmissions.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the procedure business.

Accomplishments

  • Partnered with the case management team to reduce hospital readmissions below industry benchmarks by 45% by reforming utilization review policies.
  • Minimized administrative denials due to clerical errors by partnering with product to enhance system integration features, contributing to a 43% reduction in errors.
  • Spearheaded the transition to electronic authorization systems, cutting manual processing times for key services by 45%.
  • Worked alongside the quality assurance team to develop utilization benchmarks that aligned with market best practices and reduced variance by 75%.
  • Played a lead role in ensuring compliance with PMP accreditation during comprehensive review, achieving full certification renewal ahead of schedule.
  • Facilitated weekly utilization and case review meetings with finance, ensuring cross-functional alignment and improved stakeholder communication.
  • Developed a comprehensive utilization review training program that improved review staff accuracy, cutting improper denials by 49%.
  • Facilitated insurer-provider collaboration to establish clear guidelines for specialty center referrals, reducing referral rejections by 57%.
  • Coordinated with payers to address utilization trends, enhancing inpatient/outpatient utilization ratios in line with national benchmarks.
  • Reduced average wait time for medical necessity decisions by implementing a new review process, decreasing turnaround time by 14 days.

Affiliations

  • Toastmasters
  • American Medical Informatics Association
  • American Academy of Professional Coders (AAPC)
  • Association for Computing Machinery
  • Certified Professional in Healthcare Quality (CPHQ)
  • Project Management Institute
  • American Institute of Healthcare Compliance (AIHC)
  • American Marketing Association
  • National Association for Healthcare Quality (NAHQ)
  • Healthcare Financial Management Association (HFMA)

Certifications

  • Case Management Licensing Board Certification Washington
  • Certified Professional in Healthcare Risk Management (CPHRM)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Case Management Administrator (CCMA)
  • CompTIA A+ Technician
  • Cisco Certified Network Associate (CCNA)
  • Healthcare Management Certificate – Northwind
  • CompTIA Security+
  • Certified Health Data Analyst (CHDA)
  • Certified Healthcare Financial Professional (CHFP)

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