
Analytical and patient-focused healthcare professional with 20+ years combined experience in operations, compliance, informatics, and clinical care. Brings a strong foundation in quality improvement, data-driven decision-making, and cross-disciplinary collaboration through experience in hospital-based radiology, clinical informatics, and finance operations. Adept at communicating with patients and providers, managing complex workflows, maintaining accuracy under pressure, and supporting clinical decision-making. Proficient in Microsoft Office applications including Excel, Word, and Outlook.
Board Credentials- Abdomen, OB/Gyn
Develop team-based and performance management strategies that support value-based care, Accountable Care Organization processes, CMS regulatory requirements, and health equity. Using dashboard reports, gather and submit clinical data to meet performance measures. Identify gaps in care and develop strategies for clinical coordination and community outreach.
• Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
• Prioritized and organized tasks to efficiently accomplish service goals.
• Worked with cross-functional teams to achieve goals.
• Hired and onboarded team members to meet immediate and expected demand.
• Evaluated and enhanced workflow to implement best practices to align with compliance and legal departments.
• Maintained accurate records relating to all aspects of risk assessment activities undertaken by the organization.
• Advised senior management on issues or updates related to risk compliance matters.
• Ensured compliance with applicable federal regulations such as Bank Secrecy Act regulations.
• Investigated fraud claim, assessed case details, identified discrepancies and determined appropriate course of action.
• Participated in meetings with internal departments as necessary to discuss disputed claims or other related matters.
• Maintained accurate records of all claim activities in accordance with company policies.
• Advised customers on filing requirements, documentation needed, and other matters pertaining to their claims.
• Gathered proper documentation and data to prepare claims for submission.
• Conducted investigations to gather evidence in support of claims resolution
• Answered incoming calls, providing frontline customer support or assistance with product and service transactions.
• Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
• Remained calm and professional in stressful circumstances and effectively diffused tense situations.