him specialist 1 resume example with 9+ years of experience

(555) 432-1000,
, , 100 Montgomery St. 10th Floor
Industrious and forward-thinking Senior Executive Assistant with an accumulated 5+ years of experience in professional healthcare and administrative work. Actively seeking immediate employment. Capable of smoothly handling strategic planning, operational and administrative requirements. Results-driven and hardworking with skill and resilience to achieve daily operational goals. Focused on maximizing executive productivity by providing exceptional service and coordinating team activities.
  • Epic/Maestro
  • Microsoft Office Expertise: Word, Excel, Publisher,
  • PowerPoint, Exchange, and Outlook
  • Team and detailed Oriented
  • Professional Development
  • Management information systems
  • Organized and detail-oriented
  • Time management and prioritization
  • Interpersonal and Communication skills
  • Skills
  • Administrative, Multi-tasking
  • Benefits, Negotiation
  • Billing, Network
  • Budgets, Problem resolution
  • Call center, Profit
  • CMS, Coding
  • Interpersonal and Communication, Researching
  • Clients, Scheduling
  • Client, Supervision
  • Customer service, Telephone
  • Database, Phone
  • Detail-oriented, Time management
  • Product development
  • Documentation
  • Email
  • Finance
  • Financial
  • Insurance
  • Maestro
  • Access
  • Excel
  • Exchange
  • Microsoft Office
  • Office
  • Outlook
  • PowerPoint
  • Publisher
  • Word
  • Management information systems
  • Multi-line telephone
Education and Training
Liberty University Lynchburg, VA Expected in 2018 Master of Arts : Human Service Counseling - GPA :
Shaw University Raleigh, NC Expected in 2015 Bachelor of Arts : Criminal Justice - GPA :
St. Charles Health System - Him Specialist 1
Sisters, OR, 03/2020 - 01/2021

Streamlined daily operational efficiency by serving as a frontline catalyst with task as described (but not limited to) below:

  • Analyzed (EMR) electronic medical records to ensure compliance with regulatory, government, and facility specific policies.
  • Promoted company viability by utilizing internal database to house account specific information such as : provider specific-deficiencies, qualitative and quantitative resolutions for provider related issues, and quality assurance documentation.
  • Monitored the status of incomplete medical records, generated physician reminder notices, prepares and submits a list of delinquent providers Medical Staff and Administrative Leaders.
  • Provided knowledgeable and accurate explanation of the record completion process within Maestro Care to medical providers.
Riccobene Associates Family Dentistry - Revenue Cycle Analyst
Charlotte, NC, 09/2016 - 10/2020

Operational/Administrative Task:

  • Managed accounts daily and effectively via EPIC.
  • Communicated with clients/patients on product development, product availability, and documentation and price options to increase profit margins.
  • Delivered exceptional account service to strengthen customer integrity and retain accounts while increasing revenue growth on an average of 90% under minimal supervision.
  • Coordinated and oversee special projects, establishing deadlines, monitoring open actions and maintaining the scope of project.
  • Analyzed insurance coverage and benefits for services provided to ensure accurate and timely reimbursement.
  • Was responsible for account and product reconciliations.
  • Accessed patient information through a variety of office software applications, mainly EPIC systems.
  • Maintaining strict confidentiality to remain compliant with HIPAA regulations.
  • Generated detailed reports outlining billing, flagged items, and other important data.
  • Maintained current working knowledge of CMS, Medicare and Medicaid reimbursement, billing and collection requirements, including federal and state payers.
  • Researched and coordinated over 100 claim denials and appeal strategies in coordination with other departments such as Patient Access, HIM, Case Management, etc.
  • Managed DRG and APC reimbursement, OCE, CCI and Medicare billing edits used by Patient Financial Services.
  • Collaborated with all relevant parties to resolve billing issues, insurance claims and patient payments.
  • Provided complete and accurate medical records for review by attorneys, outside agencies and/or third-party payers.
  • Identified, reviewed, analyzed, processed and completed first party and third party encounters and billing-related activities.
  • Processed requests ensuring timeliness, accuracy and completeness of information.
  • Reviewed third party payer payments, explanation of benefits/payments and other correspondence received to assure accurate processing has occurred through EPIC systems.
  • Interacts with the business stakeholders and subject matter experts in order to understand their problems and needs.
Devoted Health - Billing Administrative Representative
Tampa Bay, FL, 09/2014 - 08/2016
  • Provided general supervision, operates as part of the care team performing a variety of functions Greeting patients, registered and pre-registered patients with accurate patient demographic and financial data, insurance coverage and reliability verification, scheduling and telephone management, verifying insurance and benefits.
  • Consistently updated patient insurance coverage and complete managed care waivers for patients considered out of network.
  • Assisted with Prior authorizations and verification of benefits/insurance, Billing and Coding Co-payments.
  • Provided front desk support and customer service satisfaction to patients in a courteous and professional manner in accordance with performance standards.
  • Balanced cash sheet and cash drawer in accordance with performance standards.
  • Operated a multi-line telephone console, answering phone calls, contacting current patients to confirm appointments, Route calls to appropriate resources EPIC Maestro Care Software.
  • Assisted with insurance posting and billing, contacting insurance companies and Medical Plan carriers, contacting current patients to schedule appointments; other general duties as required.
Blue Cross Blue Shield Of NC - Membership operations Analyst
City, STATE, 06/2011 - 09/2014
  • Assisted BCBSNC agents via incoming call center with member and insurance related questions.
  • Enrolled members for plans and provided information on claims, co-pays, deductibles and co-insurance.
  • Processed all insurance claims.
  • Working knowledge of CMS on and off exchange Marketplace products and guidelines.
  • Proactively service agents with researching member enrollment, finance and commission questions.
  • Provided timely resolution to agent inquiries in writing and by phone regarding billing, benefits, claims, underwriting and pharmacy.
  • Communicated with attorneys, realtors, customers and third-party servicers via phone and email daily in order to ensure communication throughout membership process.
  • Regulated over 25 billing and account adjustments to maintain departmental budgets and infrastructure.
  • Provided daily reports and suggestions to senior level management to identify and eliminate potential problems concerning status of work and case files.
  • Exercised effective negotiation skills with customers involving client enrollment and maintenance.

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Resume Overview

School Attended

  • Liberty University
  • Shaw University

Job Titles Held:

  • Him Specialist 1
  • Revenue Cycle Analyst
  • Billing Administrative Representative
  • Membership operations Analyst


  • Master of Arts
  • Bachelor of Arts

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