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Zeno Murphy
Medical Reimbursement Specialist
Summary
Experienced Medical Reimbursement Specialist with a proven track record of success in managing complex reimbursement processes. Expertise in medical billing and coding, insurance verification, and patient accounts management. Proficient in Medicaid and Medicare reimbursement and have a deep understanding of industry best practices and legislative changes. Skilled in collaborating with healthcare providers and insurance carriers to ensure timely and accurate reimbursement. Proven ability to develop and implement strategies to improve claim processing efficiency and reduce turnaround time.
Education
Bachelor’s Degree in Healthcare Administration
October 2019
Skills
- Medical Billing and Coding
- Insurance Verification and Authorization
- Patient Accounts Management
- Medicaid and Medicare Reimbursement
- Charge Entry and Posting
- Denial Management
Work Experience
Medical Reimbursement Specialist
- Managed a team of reimbursement analysts, providing training, mentorship, and support to ensure consistent and accurate reimbursement practices.
- Stay updated on industry best practices and legislative changes impacting reimbursement policies, maintaining compliance and optimizing reimbursement outcomes.
- Developed and maintained strong relationships with insurance carriers, ensuring smooth communication and timely resolution of reimbursement queries.
- Used advanced software and databases to automate reimbursement processes, increasing efficiency and reducing errors.
Medical Reimbursement Specialist
- Examined over 500 medical claims daily to determine eligibility for reimbursement, ensuring compliance with insurance policies and government regulations.
- Analyzed and processed medical bills, calculating reimbursements accurately and efficiently, resulting in timely payments to providers.
- Collaborated with healthcare providers to resolve complex reimbursement issues, providing clear explanations and guidance to ensure seamless claim processing.
- Developed and implemented strategies to improve claim processing efficiency, leading to a 25% reduction in claim turnaround time.
Accomplishments
- Developed and implemented a new claims submission process that reduced claim rejections by 25%, optimizing revenue.
- Collaborated with insurance providers to negotiate favorable reimbursement rates, increasing revenue by 6%.
- Improved billing accuracy by 10% through comprehensive audits and error analysis, resulting in increased reimbursements.
- Trained new staff on medical reimbursement principles and best practices, ensuring a highly skilled team.
- Developed a comprehensive denial management strategy, reducing denials by 8%, improving cash flow.
Awards
- Received the Excellence in Medical Reimbursement award for exceptional performance in revenue cycle management.
- Recognized by the American Health Association for innovative solutions in medical reimbursement.
- Received the Rising Star in Healthcare Finance award from the Healthcare Financial Management Association.
- Recognized for Outstanding Contribution to Reimbursement Management by the National Healthcare Revenue Management Association.
Certificates
- Certified Professional Coder (CPC)
- Certified Reimbursement Specialist (CRS)
- Certified Medical Reimbursement Specialist (CMRS)
- Certified Healthcare Reimbursement Specialist (CHRS)
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How To Write Resume For Medical Reimbursement Specialist
- Highlight your expertise in medical billing and coding, and your understanding of insurance policies and government regulations.
- Showcase your ability to analyze and process medical bills accurately and efficiently.
- Emphasize your experience in resolving complex reimbursement issues and collaborating with healthcare providers.
- Quantify your achievements in improving claim processing efficiency and reducing turnaround time.
- Demonstrate your leadership skills by highlighting your experience in managing a team of reimbursement analysts.
Essential Experience Highlights for a Strong Medical Reimbursement Specialist Resume
- Examine medical claims to determine reimbursement eligibility according to insurance policies and government regulations
- Analyze and process medical bills to calculate accurate reimbursements and ensure timely payments to providers
- Resolve complex reimbursement issues by collaborating with healthcare providers and providing clear explanations and guidance
- Develop and implement strategies to streamline claim processing and reduce turnaround time
- Manage a team of reimbursement analysts, providing training, mentorship, and support
- Maintain compliance with industry best practices and legislative changes impacting reimbursement policies
- Establish and maintain strong relationships with insurance carriers to facilitate smooth communication and timely resolution of reimbursement queries
Frequently Asked Questions (FAQ’s) For Medical Reimbursement Specialist
What are the key responsibilities of a Medical Reimbursement Specialist?
The key responsibilities include examining medical claims, analyzing and processing medical bills, resolving complex reimbursement issues, developing strategies to improve claim processing efficiency, managing a team of reimbursement analysts, maintaining compliance with industry best practices, and establishing strong relationships with insurance carriers.
What are the educational requirements for becoming a Medical Reimbursement Specialist?
A bachelor’s degree in healthcare administration or a related field is typically required.
What are the career prospects for Medical Reimbursement Specialists?
Medical Reimbursement Specialists are in high demand due to the increasing complexity of healthcare reimbursement. They can advance to roles such as Reimbursement Manager, Director of Reimbursement, or Healthcare Consultant.
What are the challenges faced by Medical Reimbursement Specialists?
The challenges include staying updated on industry best practices and legislative changes, resolving complex reimbursement issues, and ensuring compliance with insurance policies and government regulations.
What skills are essential for success as a Medical Reimbursement Specialist?
Essential skills include medical billing and coding, insurance verification, patient accounts management, Medicaid and Medicare reimbursement, and strong communication and interpersonal skills.