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Skills

  • Insurance authorization resolutions
  • Clinical outcome optimization
  • Home health care expertise
  • Healthcare compliance regulations
  • Supervision
  • MS Office
  • Regulatory compliance
  • Communications
  • Relationship development
  • Health information systems (HIS) expertise

Work Experiences

  • Analyzed complex, high-cost medical cases in collaboration with clinicians, securing payer approval in 73% of cases.
  • Advised interdisciplinary teams on the criteria for concurrent reviews, leading to a consistent 44% approval in outpatient services.
  • Achieved 73% increase in utilization accuracy.
  • Achieved a 66% improvement in compliance.
  • Discovered alternative pain-management techniques to avoid the overuse of opiates and other narcotics.
  • Determined the best treatments to achieve body balance.
  • Used therapeutic treatments like program, category, and program to help patients with their pain and injury healing.
  • Interpreted the findings and proposed intervention strategies, which included short- and long-term objectives, as well as frequency and duration.
  • Achieved results in 2023.
  • Analyzed patient utilization data to identify areas for cost-saving opportunities, leading to a 6% lower healthcare expenditure.

Summaries

  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the standard business.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Skilled at tracking results and prescribing long-term health exercises.
  • Achieved Outstanding Service Award recognition for excellence.
  • Aligned care with initiative.
  • Consistently reduced inaccuracies in reimbursement.
  • Collaborated with insurance companies and healthcare providers.
  • Attained 65% approval rates in outpatient care.
  • Collaborated with utilization management and legal teams.
  • Analyzed patient utilization data.

Accomplishments

  • Reduced medical procedure denial rates by 27% after implementing a streamlined review process.
  • Trained and mentored 17 new UM specialists on proper documentation and reporting methods, leading to a 59% compliance increase.
  • Collaborated across departments to reduce length of stay, achieving a 70% improvement in patient flow and timely discharges.
  • Validated medical necessity for 6 cases per week, ensuring appropriate care alignments while saving the department 8 annually.
  • Led multiple external audits and achieved no sanctions or penalties by strictly adhering to regulatory compliance standards in 2016.
  • Analyzed utilization data for 13 healthcare providers, identifying cost-saving opportunities by consolidating services, which reduced overhead by 7.
  • Advised on utilization trends to inform strategy, which directly led to a 3 reduction in patient care costs, with no quality degradation.
  • Spearheaded the creation and administration of Power BI to audit UM processes, which resulted in 4 fewer errors in claims submissions.
  • Implemented new HIS analytics tools to monitor care trends, helping the organization detect and prevent method occurrences by 36%.
  • Regularly evaluated case management workflows, which resulted in a 82% improvement in the timely completion of UM reports.

Affiliations

  • American Case Management Association (ACMA)
  • National Association of Healthcare Access Management (NAHAM)
  • Certification in Prior Authorization from Beacon Labs
  • National Certification in Revenue Cycle Management (NCRCM)
  • Association for Supply Chain Management (APICS)
  • Society of Women Engineers
  • Association of Information Technology Professionals
  • Lions Club
  • Health Utilization Management Workshop Series by Harbor & Co.
  • Member, Population Health Management Association (PHMA)

Certifications

  • Registered Health Information Technician (RHIT)
  • Board Certified Patient Advocate (BCPA) Phoenix
  • Certified Business Analysis Professional (CBAP)
  • Certified Professional Healthcare Risk Manager (PHRM)
  • CompTIA Security+
  • First Aid/CPR Certified
  • Google Certified Professional Cloud Architect
  • CompTIA Network+
  • Certified Professional Coder (CPC)
  • Microsoft Certified Systems Engineer (MCSE)

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