Business Analyst Resume Covington, GA - Hire IT People

Objective

Dedicated and Motivated Health Information professional with claims, payment/adjudication, coding, billing, medical payment policy and project management, seeking to aid an organization in obtaining its goal by utilizing acquired skills and experience.

Professional Experience

Confidential, Atlanta, GA 2008 – Current
Healthcare Business Analyst

Manages, writes, edits, evaluates and analyzes healthcare policy and procedure and implement changes to enhance system, rule maintenance, rule application and configuration.
Provides implementation support for clients in preparation for the production environment and Conduct project request, research request and rule maintenance audits.
Attends weekly client team meetings to discuss reporting functions, system configuration, global and periodic updates.
Coordinates and communicates with manager and client team regarding status of assigned projects.
Successfully and accurately perform a bulk load application process for the following: CCI deviations, Max Units, DME Max Units over time and ICD-CPT link
Identifies and recommends operational improvement opportunities through reporting process and trend analysis.
Reviews and analyzes denied claims and make recommendations.
Develops ad-hoc reports and prepares detail and summary level reports including written interpretation of analytic results.
Analyzes professional, DME, outpatient claims data and complex problems through oracle database, business objects and Rule maintenance interface.
Assures data quality through accuracy, consistency and completeness of coding, abstracting and Q & A functions.

Confidential, New York, NY 2002 – 2006
Senior Billing/Enrollment Analyst

Accurately posts provider and member payments, including account adjustments and verified insurance coverage.
Coordinated all activities pertaining to the operations of billing, AR, collections of client service to ensure the timely and accuracy processing of client’s request.
Providedanalysis to the health care team for identification of improper payments.
Obtained information to resolve enrollment/billing ssues and discrepancies.
Coordinated actions necessary to correct account balances and pursued delinquent accounts in accordance with established collection procedures.
Managed and reviewed all billing information prior to bill print and reconciled 1,244 commercial insurance accounts utilizing MS Access and Excel.
Collaborated with healthcare teams and Health Plan operations managers to interpret contract and benefits.

Health Record Analyst 2000 - 2002

Analyzed incoming release of information requests.
Managed chart completion (assigned ICD-9-CM and CPT 4 coding/abstracting).
Worked collaboratively with patient account department to ensure accurate
Assisted with physician notification, follow-up and release of information.
Reviewed medical documentation and consulted with healthcare providers.
Reviewed records for completeness, accuracy and complied with regulations.

Confidential, Great Neck, NY 1993 – 2000
Health Information Coordinator

Monitored and maintained medical records department, 6-person payroll, staff evaluation, medical records review and medical records report.
Managed chart completion (assigned ICD-9-CM, HCPCS and CPT 4 coding/abstracting).
Maintained record of correspondence requests in a standard format in the ROI Log/Request database.
Collaborated with medical and administrative staff to develop methods to evaluate patient care utilizing health care information.
Quality assurance - technical support, data collection, report compilation.
Ensured all entry in CDM are direct reflections of chargeable & billable services.
Reviewed and updated, charges, pricing, billing and procedure codes for all healthcare-related services in CDM.
Reviewed patient charts to determine appropriate charges; follows up with nursing staff on missing documentation/charges; reconciles daily reports compared to actual charges, codes and documentation.

Education

B.S., Health Information Management

Skills

Advance knowledge of MS Office, Lotus Notes, Data Analysis, Business Object, MS, CRM, CDM, QA, HMO, PPO, Citrix, insurance verification, member accounting, billing and reimbursement system, EOBs, UB92, HCFA 1500, ICD-9-CM, CPT coding, DRGs and APCs assignment, CCI edits, Medical Terminology, HIPAA regulations, Managed care protocols/JCAHO guidelines, HCPCS codes, CMS/HCFA regulations, credentialing, pre-registration, Oracle, Ad-Hoc reporting, V-Lookups, Physician Fee Schedule, ACS and CMS portal and accreditation standards.

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Business Analyst Resume

Covington, GA

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