denials manager resume example with 14+ years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA94105
:
Summary
Effective at improving revenue, team productivity and policies to keep a facility operating at a sustainable and profitable level. Well-versed in motivating and retaining employees. Detail-oriented and extremely knowledgeable in all aspects of healthcare billing and denials. Skilled in the most efficient ways to get denials overturned, identifying large scale issues and opportunities to increase revenue and improve workflow processes. Always pushing to learn more and broaden my skillset in any field I am in.
Skills
Extensive knowledge of Meditech, ECW, RCI Aurora, Change Healthcare and most Insurance Payer websites
Basic skills in Excel and Power Point
Excellent communication abilities both written and verbal
Exceptional problem solving abilities
Management experience
In-depth understanding of health insurance guidelines and processes.
Broad understanding of patient registration, coding, authorizations and how each step affects cashflow.
Education and Training
Norwood-Norfolk Central SchoolNorwood, NY, Expected in 06/2004 ā āHigh School Diploma: - GPA:
Community Health System - Denials Manager Venice, FL, 08/2019 - 07/2020
Exceeded initial goal of recovering $1.2 million of revenue within first 3 months of hire.
Reduced Denials by over 1,000 initial denials per month from 2019 to 2020.
Assisted Leadership Team with development of weighted productivity measures for billing, collections and cash posting teams.
Implemented improved processes and workflows for staff leading to consistent decreases in A/R as well as increased collection of revenue.
Monthly reporting of denial trends to Leadership across the organization. Utilized Meditech and RCI (Aurora) reporting tools to develop regular trending reports. Used Excel and Powerpoint to report universally across the organization in a way that was organized, easy-to-read and understand for all department leaders.
Organized data for management across the organization as requested to highlight areas for improvement within their respective departments. Communicated regularly based on monthly denial trends identified within reports to improve processes and reduce initial denials.
Researched and communicated all insurance guidelines and updated necessary departments of changes to ensure appropriate billing of services.
Main point of contact for payer representatives from all major insurances. Worked regular projects to identify large scale payer issues and follow through to completion.
Assisted billing/collections staff daily with questions/issues regarding billing requirements, system edits, denials and patient disputes of billing or benefit explanations.
Assisted in denial specific training of new hires.
Along side team members, conducted interviews to fill vacancies within the Patient Financial Services department.
Led monthly team meetings for multiple teams within department to discuss current issues, trends and implement solutions as well as encourage open communication.
Held one-on-one meetings with all staff within department to resolve issues, evaluate needs for training and identify individual opportunities for improvement as well as address any concerns with leadership.
Conducted department "huddle" three times per week to communicate changes from management, insurance companies and address staff questions/concerns.
Cci Health & Wellness Services - Patient Representative Greenbelt, MD, 07/2015 - 07/2019
Initial two years in billing department, focused on Excellus Blue Cross Blue Shield billing and collecting.
Transitioned to Lead Commercial Collector after 2 years.
Responsible for training all new hires on commercial team.
In charge of multiple special projects including maintaining a weekly spreadsheet with our Outbound Representative to work and obtain payment on problem accounts.
Focus on working insurance denials and using knowledge and research to obtain payment from various payers.
Work with other departments to ensure accurate billing/coding.
Handle concerned patients when calling/presenting to office to ensure proper understanding of patient statements and specific insurance benefits.
Monitor trends with insurance companies and identify large scale issues to bring to the attention of management.
Ratner - Assistant Practitioner Staunton, VA, 06/2013 - 06/2015
Responsible for daily care of individuals with developmental disabilities.
Ensuring individual daily program goals were met and properly documented.
St. Lawrence NYSARC - Receptionist City, STATE, 07/2005 - 06/2013
Greeted visitors, assessed needs and directed to appropriate personnel.
Answered and directed incoming calls using multi-line telephone system and in-house paging system in a professional and efficient manner.
Sorted and distributed business correspondence to correct department or staff member.
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