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Skills

  • Adaptation to new technologies
  • Insurance Claims Coordination
  • Deadline adherence
  • Problem-solving in high-pressure situations
  • HIPAA compliance
  • Data entry and management
  • Customer service
  • Problem resolution
  • Budgets
  • Patient case management

Work Experiences

  • Acted as the first point of contact for external auditors during reviews, ensuring timely response to all inquiries.
  • Achieved a reduction in paper use by 45%.
  • Collaborated with engineering to streamline workflows.
  • Collaborated with case managers.
  • Conducted environment-of-care compliance checks.
  • Ensured completeness in medical documentation.
  • Achieved a 20% reduction in response time.
  • Enabled better forecasting and decision-making.
  • Collaborated with case managers to track patients' progress and ensure post-discharge follow-ups.
  • Was in charge of financial documents like expense reports and invoices.

Summaries

  • Communicated regarding coverage and authorizations.
  • Achieved a 27% increase in data retrieval efficiency.
  • Healthcare practices, compliance standards, and operations are all familiar territory for this versatile administrative professional.
  • Adept at ensuring regulatory compliance.
  • Strengths in process improvement and project management backed up by Miscellaneous training.
  • Opportunity to learn German was pursued in order to improve support for metric populations.
  • Advanced understanding of healthcare compliance regulations.
  • Exceptional attention to detail, collaboration, and typing skills.
  • Achieved annual savings of $8 in supply and labor costs.
  • Adaptable in fast-paced healthcare environments.

Accomplishments

  • Partnered with case managers to resolve 15 complex claim disputes, resulting in a 29% increase in first-attempt approval rates.
  • Served as a principal liaison between clinical and administrative teams, resolving discrepancies and expediting approval processes for over 5 cases monthly.
  • Updated and maintained patient records in metric, ensuring 100% compliance with insurance claims processing standards and improving efficiency.
  • Collaborated with team of 8 in the development of framework.
  • Improved reporting methods by introducing automated data-tracking tools, enabling a 75% increase in performance transparency in utilization review.
  • Contributed to a Outstanding Service Award by leading risk mitigation strategies that anticipated compliance issues, successfully saving the company $3 in penalties.
  • Led effort in 2020 to consolidate multiple paper-based systems into a digital format, reducing overhead costs by $18 annually.
  • Ensured 100% confidentiality and HIPAA compliance while managing sensitive patient documents across various administrative and clinical teams.
  • Designed and conducted a training program for administrative staff on insurance and EMR systems, which improved overall team efficiency by 23%.
  • Created a comprehensive filing system for patient records, reducing document retrieval time by 63% while enhancing the organization’s readiness for audits.

Affiliations

  • Society of Human Resource Management
  • Completed a course in medical terminology through the American Medical Technologists (AMT)
  • Rotary International
  • National Association of Social Workers
  • Member of the National Alliance of Healthcare Purchaser Coalitions (NAHPC)
  • Completed a data analysis certification course with standard
  • Active in the Utilization Review Accreditation Commission (URAC) professional forums
  • Member of the Case Management Society of America (CMSA)
  • Completed training in medical coding and billing via the American Academy of Professional Coders (AAPC)
  • Association for Supply Chain Management (APICS)

Certifications

  • Certified Health Data Analyst (CHDA) by AHIMA
  • First Aid/CPR Certified
  • Certified Medical Office Manager (CMOM)
  • Certified in Healthcare Compliance (CHC) by HCCA
  • Certified Professional Coder (CPC) by AAPC
  • Medical Administrative Specialist Certification
  • Electronic Health Records Specialist Certification (EHRS)
  • Certified Healthcare Access Associate (CHAA)
  • Healthcare Compliance Certification (CHC)
  • SHRM Certified Professional (SHRM-CP)

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