Experienced Medical Administrative Professional with 10+ years of experience and a significant background in progressive administrative and nursing roles within the medical industry. Experienced in reviewing complex healthcare claims, coordinating new hire training, and leading cross-functional teams. Equipped with a keen ability to manage large-scale projects, implement process improvements, and foster positive rapport with vendors, patients, co-workers, and members of executive management.

Medical Administration Project Management Training / Development Policy Development

HIPAA Regulations Medical Claim Management Team Leadership Case Management

Process Improvement Discharge Planning Emergency Management Six Sigma Methodologies

  Direct daily administrative and operational functions within a fast-paced environment with a focus on increasing claim accuracy and efficiency levels

  Review complex data and make appropriate clinical decisions based on regulatory best practices, medical records, medical necessity, and company guidelines/policies

  Analyze claims and determine if accounting adjustments need to be made, work closely with various internal teams, and acted as a subject matter expert in regards to clinical documentation, revenue opportunities, and regulatory changes

  Perform market trend analysis to determine opportunities for revenue, ensure claims are in compliance with regulatory standards, and supervised Revenue Integrity team members

  Oversee classroom operations within a higher education environment which required designing and implementing comprehensive lesson plans and assignments

  Ensure that State of Florida nursing best practices are demonstrated within course curriculum, provide curriculum related to medical ethics, and monitor student clinical experience

  Utilize superior communication and interpersonal abilities to maintain communication with local universities and clinical sites in addition to providing individualized guidance to students as needed

  Coordinated medical functions within a fast-paced emergency department which required triaging incoming patients, developing treatment plans, and administering medications

  Designed and implemented innovative policies aimed at improving productivity levels, complete detailed quality reviews, and implement departmental safety goals

  Supervised nursing staff members which required providing individualized coaching and feedback in addition to assisting patients with complaints, abnormal imaging, prescription needs, Physician referrals, and plan of care follow-up

  Instrumental in the completion of credit, risk management, and hospital audits and acted as a Super-User for internal systems such as Meditech, T-System, HPF, PACS, EAR, and EDM

  Cared and supported patients during endoscopy procedures along with providing post-procedure sedation and/or anesthesia care

  Maintained a significant knowledge or clinical endoscopy/gastroenterology laboratory skills, educated patients on procedures, and supervised quality assurance reviews