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Senior Business Analyst Resume

Franklin, TN

SUMMARY:

  • Specialize in process improvement and documentation, workflows, training, and project management.
  • Attention to detail, strong critical thinking skills, accounting principles, budgeting and forecasting.
  • EDI 835/837, 276/277, ANSI 5010, and CPT/ICD - 10.
  • CMS medical billing regulations, RAC audits, payer reimbursement and cash posting, claims denial analysis, claims billing & collections for all payers, and root cause trending.
  • Collaborate with other IT programmers, the vendor, client, and business partners to ensure deliverables are met timely.
  • 15+ years of experience in Revenue Cycle, Project Management, and technical support within financial applications.
  • Very strong HMS/Medhost experience with multiple years of experience creating and running queries, implementations, conversions, configurations, and software development.
  • Build of financial applications by entering data fields, system/server interfaces, configurations, setup and schedule automated jobs, create workflows, pools, and queries; QA data and remediating defects, promoting software to production.

PROFESSIONAL EXPERIENCE:

Confidential

Senior Business Analyst, Franklin, TN

Responsibilities:

  • Consultant to implement financial applications (Artiva and Hyland Onbase) by system configurations and server interface, while consolidating business office functions into a Shared Service Center
  • Implemented Artiva and consolidated 18 hospitals into the Shared Service Center; assisted UAT & QA for Hyland Onbase for an entire Shared Service Center (containing 24 hospitals)
  • Automated UAT {User Acceptance Testing} using QA Complete (aka Smartbear; an HP Quality Center testing tool) to ensure cash posting and EDI 835 automation functionality; built test cases/scripts/scenarios for iterations
  • Conducted routinely conference calls with clients for business and system requirements gathering
  • Perform reconciliations by payer and financial class to ensure all AR matches within host system to application
  • Ensure 835 files and HMS data files are importing correctly by writing FTP scripts
  • Process improvement, created documentation: Quick Reference Guides, process flowcharts utilizing Visio, and SOPs {Standard Operating Procedures}
  • Working knowledge of AS400/Medhost, Artiva, Hyland Onbase, QA Complete (Smartbear), MS Visio, MS Project, FileZilla, EDI 835/837, 270/271, 276/277, SQL, iSeries Navigator, agile environment, and Daptiv

Confidential

Director of Operations, Hendersonville, TN

Responsibilities:

  • Oversee and manage special projects of self-pay collections whereas providers (hospitals and physician practices) have contracted out their 1st party self-pay collections (HB/PB)
  • KPI metrics: re-educate all staff on best practices, brought resolution to 3,000 dead/unresolved accounts, and achieved collection goals of $2m on new insurance found accounts. Reduced bad debt allowance write-off from 30,000 accounts ($16m) to 7,000 accounts ($800k)
  • Conduct business sessions, biweekly/monthly conference calls with providers to review goals, achievements, and assess their business needs
  • Design, Build and Maintain smart templates for PowerPoint decks for client leadership and business partners of monthly recoveries
  • Conduct month-end client invoicing, ad hoc reports
  • Lead a team of 45+ employees (project managers, team leads, and customer service reps) and preforming all HR duties: job fairs, interviewing, hiring, disciplinary actions, evaluations, terminations, etc.
  • Working knowledge of H.I.S. and EMR patient accounting applications: Epic, Cerner, AS400/HBOC, McKesson (STAR), FACS, Mede Analytics, Prism, LiveVox, Care Cloud, Microsoft Excel, PowerPoint, & Word, MS Project

Confidential

Financial Analyst, Nashville, TN

Responsibilities:

  • Working knowledge of MS Dynamics AX, MS SQL Report Writer, SharePoint, ServiceBench, and Excel (pivot tables, vlookups, functions, and formulas)
  • Provide financial & BI analysis support for a global retail client within their revenue cycle claims processing, with a $6 million monthly spend
  • Assign GL account numbers and prepare cash/check/credit card payments for deposit
  • Resolve discrepancies with outstanding invoices and clear unapplied cash
  • Provide cost analysis to provide information that drive decision making capabilities
  • Manage day to day revenue recognition, billing and AR for multiple product lines
  • Perform general ledger reconciliations and month end closing functions (journal entries, profit and loss statements)

Confidential

RCM Account Manager, Nashville, TN

Responsibilities:

  • Manage processes for all aspects of revenue cycle: professional claims billing, collections, cash applications, AR reporting for 38 employer sponsored health centers
  • Manage, assign special projects, & audit offshore teams and onsite billers, collectors, cash posters, & claims scrubbers for daily operational functions Developed Power Plans and Physician workflow with CMIO and physician support staff
  • Resolve escalated denials, billing inquires, patient disputes, & write-offs/adjustments/refunds due to bad debt or client requests
  • Create ROI reports for utilization analysis; identifying costs and expenses of health centers’ types of visits to determine profitability
  • Perform technical business analysis; create logic for PrimeSuite (clinical) programming, & documenting of AR reporting for process improvements, automation, project planning & (agile) implementations

Confidential

Revenue Cycle Implementation Analyst, Nashville, TN

Responsibilities:

  • Proficiently implement (Claim Master & its add-on products) billing, denial management, ERA posting, claims status (for Medicare, all Medicaid, Managed MCO, HMO/PPO, Commercial, BCBS, Tricare, & all other payers), eligibility, Medicare Manager, {ensuring proper postings for Parts: A,B,C,D}, Automated Secondary billing, Accelerated Secondary billing, & high level management reporting software for clients
  • Build reports that recognize ROI at various stages of implementation, revenue recognition, forecasts, and projections on future opportunities. Accountable for forecasted projections of monthly AOV
  • Submit custom programming requests using algorithm logic, performed data extractions to create crosswalks, & payer mapping. UAT testing of software for accuracy and functionality in staging environment. Tested system interface with McKesson, Cerner, Medhost, Epic, & Healthland
  • Heavy usage of Siebel/Oracle database for agile implementation project tracking, importing & exporting EDI files from client to me (via FTP) for software build & data extraction
  • Utilizes software such as: WinSQL, Siebel-Oracle, Concur, Microsoft Office, Microsoft PowerPoint, & Kronos. Strong knowledge of SDLC

Confidential

AR Travel Team Specialist, Franklin, TN

Responsibilities:

  • Have retained collection data & BI analysis and trending root causes using Mede Analytics, proficient knowledge of all Confidential Hospitals systems & financial applications: HMS, iSeries Navigator, Compliance 360, SSI (Click On), Confidential, 835/837 ERA files, 276/277 EDI responses, McKesson Star, McKesson Series, Meditech, Med Series IV (Siemens), and Med Assets (Accuro); Passport, WinSQL, Microsoft Project, Microsoft Office: Word, Excel, PowerPoint, Access, One Note; also specialized in Medicare {Parts: A,B,C,D}, several State Medicaid payers, HMO/PPO, Commercial, and Workman’s Compensation
  • Revenue integrity - managed financial audits & liaise with payers of high volume in payment recoupments; verify CDM matches charges and compare overcharges vs undercharges against actual billed vs reimbursed
  • Interpret payer contracts to reconcile questionable charges within the charge master, ensuring CPT/HCPCS, DRG weights & all other charges match according to contract terms and agreements
  • Previously assisted in the creation of a new PFS Audit Team in 2010, with direct input on developing the audit report & implementation of its processes & procedures
  • Perform Electronic Data Interchange corrections on 835 & 837 data (ANSI 5010 format) in C360 software to provide financial support for RAC denial appeals, primarily for Medicare & Medicaid payers
  • Utilize Compliance 360 GRC for RAC audits and denials workflow, manage and identify compliance gaps, prepare audits for appealing before the ALJ by compiling all documents in the Virtual Evidence Room.
  • Train hospital staff &/or corporate new hires on HMS, & billing/collection follow up procedures according to Confidential Corporate standards; & reviewing if payment was rendered according to contract; all collection activities & billing involved. Traveling involved, up to 100%.

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