| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidate Candidate's Name
EMAIL AVAILABLE PHONE NUMBER AVAILABLEOBJECTIVETo secure a challenging Functional Analyst position leveraging over a decade of experience in healthcare finance and operations to drive organizational success.SUMMARY OF QUALIFCATION
Accomplished Budget Management professional with 10+ years of progressive expertise. Demonstrated ability to excel in remote work environments, showcasing self-management skills. Extensive background in Medicare, Medicaid, and third-party payer interactions within the healthcare insurance sector. Exceptional customer service acumen, consistently delivering satisfaction and building rapport. Results-oriented with a focus on achieving goals and driving outcomes. Purpose-driven and compassionate, contributing positively to organizational culture. Proficient communicator with strong written and verbal skills, adept at clear articulation and effective documentation.EXPERIENCEHealthcare Claims SpecialistHBCS March 2020 - Present Manages the aging of accounts receivable by trending and analyzing the A/R, and through communication with the payers/managers Provides exceptional customer service and accounts receivables management services. Responds to claim denials from insurance companies to ensure contractual payment of submitted claims Resubmit claims and write appeals to insurance companies Analyzes and resolves problems and identifies payor reimbursement discrepancies. Updates multiple systems while interacting with third parties. Read and interpret insurance Explanations of Benefits (EOB)/Remittance Advice (RA) with understanding and takes appropriate steps to resolve issues. Experience with medical providers, mental and behavior health, and dental providers. Understands the appropriate payment rates for corresponding services based on individual contractual agreements or fee
schedules. Credentialing Specialist AC& Credentialing (Part time) December 2023- Present
Managed the end-to-end credentialing process for healthcare providers, including initial credentialing, re-credentialing, and privileging. Conducted thorough primary source verification of provider credentials, including education, licensure, certifications, work history, and malpractice insurance. Maintained accurate and up-to-date provider files, ensuring compliance with organizational policies and regulatory requirements. Communicated effectively with providers to obtain required documentation and resolve credentialing issues or discrepancies. Collaborated with internal stakeholders, such as network management, legal, and compliance teams, to ensure alignment with credentialing standards and procedures. Conducted audits of credentialing files to ensure accuracy, completeness, and compliance with accreditation standards and regulatory requirements. Prepared and submitted credentialing applications to credentialing committees or external accrediting bodies. Assisted in the development and implementation of credentialing policies, procedures, and best practices to streamline processes and enhance efficiency. Stayed updated on industry trends, regulations, and best practices related to provider credentialing and enrollment. Billing Specialist Medclaim Comprehensive (Part time) February 2023 - June 2023 Reported of performance according to contracted fee schedule
Performed consistent, assertive, efficient and timely follow-up on accounts as determined by Management Interpreted payer contracts, Remittance Advices (RA) and Explanation of Benefits (EOB) statements Corrected billing errors, edits, overlaps, etc., and submit clean claims. Reviewed payment variances and remittances for resolution. Identified payer issues and trends and updated management.Medical Billing AnalystPrecise Billing Services April 2007 - March 2020 Applied and interpreted procedures or policies such as private insurance policies Obtained patient responsibility, research payer coverage criteria and any required prior authorization requirements Prepared and sent prior authorizations to insurance when required Addressed incoming billing questions from patients and/or internal team members Conducted analytical studies and provides achievement of critical recommendations for improvements to the design, implementation, and management of quality improvement strategies Processed and analyzed data and performed follow-up actions to maintain customer/client accounts Wrote correspondence to request or to clarify information; established controls for responses and initiate follow-up as needed to obtain information Reviewed correspondence and EOBs in a timely manner, identified and corrected billing errors and resubmitted claims via the appellate process Maintained administrative, reference and technical files in accordance with prescribed functional filing system Reviewed changes in insurance policy, law, and regulations to assess impacts on debt resolution policies, procedures, or other guidance Recommended solutions to resolve issues regarding program operations Provided support for special projects such as Sort Code Set ups, implementation and reporting, internal auditing and obtaining documents for audits Established and maintains relationships with key individuals and groups both internal and external of the organization such as commercial payers and provider service representatives Remained knowledgeable of the full revenue cycle and regularly contacted Medicare, Medicaid and/or commercial payors for resolution to claims not paid or claims not paid according to plan benefits Revenue Cycle Liaison
K Force January 2019 - June 2019
Prepared daily Controller's Report for VP for end of the month projections Prepared Bad Debt by Age, Bad Debt by Major Category, and Bad Debt Residual ER and NON ER reports for Financial Reporting Department Reviewed accounts that were submitted to bad debt/collection agencies Analyzed patients accounts to ensure proper billing Worked outpatient, and inpatient accounts for all 10 Medstar facilities Prepared Month-end Reports Updated insurance using Insurance Tracker Reports for self pay accounts Mailed out correspondences to collection agencies Requested medical records from agencies Represented Medstar as a witness during court hearingsAccounts Receivable SpecialistMercy Medical Center May 2013 - February 2017
Provided follow-up services until payments or rejections are received; Updated and added up to 50 patient's insurance information and eligibility verification daily Partnered with the Finance department to correct problems so that customer expectations were met Reconciled discrepancies or problems in customer/client accounts or records Analyzed and researched issues in order to present responses, recommendations and solutions in a written format Interacted with third party representatives utilizing online sites to review status and updated accounts expeditiously Processed appeals, attached UB-04 claims, itemized bills, and Medical Records for reconsideration of benefits Followed up on all unpaid and unresolved account balances, including claims rejected electronically, EOB denial and working A/R aging reports Reviewed EOB's for proper reimbursement and resolved electronic claim rejections and Explanation of Benefits denials timely Reviewed and researched insurance correspondence and made necessary corrections ensuring claims payment Assisted with credit balance resolution while completing re-bill requests to facilitate timely claims paymentIT InternMercy Medical Center May 2014 - November 2016
Documented and reported IT problems using tracking systems, ensuring accurate records of issues and resolutions. Provided comprehensive technical support by assisting with password resets, account unlocks, and remote access setup. Diagnosed technical problems remotely, ensuring minimal disruption to workflow and productivity. Responded promptly to email inquiries from customers and clients, providing efficient solutions to technical issues. Monitored network systems to identify and troubleshoot potential issues before they impacted operations. Proactively addressed network problems to prevent disruptions and maintain system reliability. Collaborated with IT team members to implement solutions and optimize network performance. Charge Entry Specialist Mercy Medical Center October 2011 - May 2013
Provided timely and accurate registration of clinical encounters; Verified insurance and ensured patient eligibility Obtained authorizations of procedures required by the insurance companies Entered charges, diagnoses and other pertinent billing information for assigned facilities Researched incomplete registration information to ensure correct billing of accounts, reviewed charge forms and EMR charges for accuracy and completeness of coding information Registered up to 120 new patient accounts daily from information obtained from the hospital systems or practices Posted payments, adjustments, and denials for manual insurance checks, patient checks and Medicaid electronic remittance to the correct client/patient/line item, by the deadline, with accuracyEDUCATIONCyber Security Foundations, University of Maryland Baltimore CountyUniversity of Maryland Baltimore County US, Maryland, Baltimore Certificate in Cyber SecuritySKILLSCOMPUTER SKILLS:Extensive experience and proficiency in Microsoft Office, Epic Systems, E-clinical Works (ECW), Medical Manager, TRMS Web, Smarts, Facets, Flexx, IACS, CSW, PV 40, PVXI, NAPS, & PVR, Real Med System, SIR, Care, Screen Surfer, Imaging, MZOO, BCIQ, BIDS, GE Centricity, Document Direct, Knowledge of CPT and ICD9 & ICD10, Image now, MPC website, CareFirst Direct Navinet, Aurora, Medi-tech, Misys, AllScripts, OneNet, Emdeon, and Passport, Electronic Enrollment Review, Sisco WebEx, EPIC, Windows, Invision, McKesson |
