Healthcare Reimbursement Specialist

Healthcare Reimbursement Specialist — Peak Ridge Medical Center

Denver, CO | June 2023 – Present

• Audited and processed over 1,200 outpatient claims weekly utilizing Epic Resolute, achieving a clean claim rate of 98.4% compared to the historical average of 91.2%.
• Investigated and resolved 450+ insurance claim denials per month, recovering $180,000 in previously uncollected revenue over a 12-month period.
• Partnered with clinical documentation teams to audit CPT and ICD-10 coding errors, reducing coding-related billing compliance issues by 27%.
• Analyzed underpayment reports from 6 major commercial insurance payers, recovering $65,000 in contractually obligated revenue.

Medical Billing and Coding Specialist — Summit Healthcare Partners

Boulder, CO | June 2021 – May 2023

• Administered medical billing and claim submissions using Cerner Millennium for a multi-specialty clinic of 15 providers, decreasing average days sales outstanding (DSO) by 18%.
• Identified and corrected 950+ ICD-10-CM diagnostic and CPT procedure code discrepancies prior to submission, preventing an estimated $45,000 in potential claim rejections.
• Trained 4 new administrative hires on medical billing guidelines, CMS-1500 and UB-04 form requirements, improving team documentation accuracy by 15%.
• Resolved patient billing inquiries and structured payment agreements for 200+ accounts monthly, increasing patient self-pay collection rates by 22%.

ICD-10-CM, CPT, HCPCS Level II, Epic Resolute, Cerner Millennium, Medical Billing, Revenue Cycle Management (RCM), Claims Denial Management, Clearinghouse Operations, HIPAA Compliance, CMS-1500, UB-04, Accounts Receivable (A/R) Follow-Up, Clinical Documentation Improvement (CDI)

EHR Billing Platform Migration

Role: Lead Reimbursement Analyst

Tools: Epic Resolute, Microsoft Excel, Waystar Clearinghouse

Coordinated the billing system transition for 3 clinical departments, completing data validation 2 weeks early and maintaining a 99.1% claim acceptance rate during launch.

Payer Underpayment Recovery Campaign

Role: Reimbursement Specialist

Tools: Cerner Millennium, Power BI, Availity

Led a 6-month audit of retrospective insurance contract payments, identifying billing discrepancies and recovering $124,000 in underpaid claims.

• Certified Professional Coder (CPC) (2022)
• Certified Revenue Cycle Representative (CRCR) (2023)

• Professional Associations: Active member of AAPC and HFMA Colorado Chapter
• Languages: English (Native), Spanish (Professional working proficiency)
• Availability: 2 weeks notice