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Skills

  • Healthcare cost analysis
  • Negotiation
  • Integration of data analytics
  • Healthcare claims processing efficiency
  • Data collection and analysis
  • Operational improvement
  • HIPAA compliance
  • Creative merchandising
  • Business Planning
  • Regulatory compliance

Work Experiences

  • Attained CPA to enhance department specialization, improving care authorization times by 4 days.
  • Advocated for patient care improvements at administrative levels, reducing unnecessary readmissions by 85% across Raleigh.
  • Created budgets and prepared quotes for new products and services.
  • Devised, implemented, and tracked processes to improve long-term business success and profit margins by 6%.
  • Used performance data to evaluate and improve operations, as well as forecast needs and target current business conditions.
  • Increased employee morale and decreased turnover by 9%.
  • Shared best practices with on-site and external personnel to align efforts and goals.
  • Looked at current operations and market trends to see where improvements could be made and where opportunities could be capitalized on.
  • Audited and revamped utilization management processes, leading to a 30% improvement in compliance with method.
  • Attained Lean to enhance department specialization.

Summaries

  • Dynamic application of client relations and workflow optimization in a fast-paced business environment.
  • Mentoring and challenging team members to meet and exceed company goals is something I'm passionate about.
  • Results-oriented, goal-oriented, and looking to apply my experience to the role of Utilization Manager.
  • Ability to use sound judgment and independent decision-making skills to positively impact company success.
  • Offering a can-do attitude and a track record of success in coordinating and monitoring operations across multiple departments.
  • With forward-thinking leadership, proven skills in increasing productivity, efficiency, and bottom-line profits.
  • Strong motivation combined with outstanding interpersonal, communication, and team-building abilities.
  • Professional with over 2 years of experience as a manager for a $8 three years revenue-generating company.
  • Focused on ensuring smooth financial, personnel, and operational operations.
  • Entrepreneur and executive-level business manager with experience running start-up and emerging companies.

Accomplishments

  • Authored utilization management guidelines that aligned with evidence-based practices, reducing non-compliant claims by 19%.
  • Led a comprehensive review of utilization management procedures resulting in a 40% reduction in time spent per case review.
  • Collaborated with the finance team to perform healthcare cost analysis, identifying cost savings of $11 in the first one year.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Analyzed trends in service denial reports and introduced corrective actions leading to a 66% reduction in denials.
  • Developed and implemented automated tools for case management, increasing productivity by 34% while reducing manual errors.
  • Led a system integration initiative that resulted in 18% faster claims processing and improved cross-departmental communication.
  • Streamlined the precertification process, reducing delays by 58% and improving patient satisfaction scores.
  • Participated in regulatory audits and maintained compliance with CMS guidelines, reducing potential penalties by $12.
  • Reduced external service utilization expenditures by 84% within the past year, contributing to an overall increase in budget efficiency.

Affiliations

  • Council on Social Work Education (CSWE)
  • Patient-Centered Outcomes Research Institute (PCORI)
  • Healthcare Information and Management Systems Society (HIMSS)
  • Lions Club
  • American Association of Healthcare Administrative Management (AAHAM)
  • Council for Affordable Quality Healthcare (CAQH)
  • Healthcare Financial Management Association (HFMA)
  • Case Management Society of America (CMSA)
  • Certified Professional in Healthcare Quality (CPHQ) Membership
  • Integrated Healthcare Association (IHA)

Certifications

  • Certified Compliance & Ethics Professional (CCEP) by standard
  • Certified Revenue Cycle Professional (CRCP-I) by method
  • CompTIA Security+
  • Certified Professional Utilization Review (CPUR)
  • Certified Case Manager (CCM)
  • Certified Healthcare Access Manager (CHAM)
  • Apple Certified Associate (ACA)
  • CompTIA Network+
  • Accredited Case Manager (ACM) by system
  • Certified Public Accountant (CPA)

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