OBJECTIVE

SUMMARY

Dedicated healthcare professional with years of Skilled Nursing medical records experience. Additional one year of experience as a Senior Healthcare Consultant in a Hospital Healthcare consulting firm setting. Proven ability to lead seamless implementations and deliver next-generation technical solutions improving revenues, margins and workplace productivity Completed full-time coding program in 2010. Expertise includes:

• UB04 forms Knowledge of ICD 9, CPT & HCPCS
• Expert in Mainframe System and Medicare Fiscal Intermediary
• Knowledge of HMO/PPO, deductibles, coinsurance, and Co-pay
• Knowledge of Hospital Contracts
• Healthcare Claims experience (Inpatient and Medical Claims)
• Certified Professional Coder
• Knowledge of licensing such CMS, reimbursement (Medicaid and Medicare part A&B) and accreditation standards
• Currently pursuing Masters in Health Information Management.
• Work expertise in documenting project process steps, standard operating procedures, and tracking trends in data.
• Acquired advanced knowledge and skills in healthcare data, information and knowledge management

EDUCATION

Masters in Health Information Technology

Bachelors in Health Administration

EMPLOYEMENT HISTORY

Confidential,New York, NY 06/2011-Present
Senior Configuration Business Analyst
Maintain the company’s patient system software by performing component configuration, analysis, and software monitoring and performance optimization. Perform functional line configuration of applications with corresponding documentation.

• Worked on configuring business rules that support reimbursement policies and methodologies in a large managed care organization. This position focused on key role in the configuration and implementation of new markets and products.
• Review hospital negotiated contracts to load necessary updates into Mainframe system and documents questions for providers
• Conducts bulk loading such as rates/fee screens and performs table management.
• Write functional specifications and end user documentation
• Works within practices and policies for writing, updating, and managing requirements to ensure repeatable processes and delivery of value

Confidential,Columbia MD 12/2009 – 05/2011
Senior Healthcare Business Analyst
Work cooperatively with client’s patient account department to ensure accurate billing and resolve claim denials and medical-necessity issues. Review medical documentation and consult with healthcare providers when documentation is inadequate for audit purposes.

• Selected Contributions:
• Maximized reimbursement by ensuring accurate ICD-9-CM and CPT coding and conducting regular quality audits of providers’ selected codes compared to chart documentation.
• Monitoring hospital claims systems and reviewing the claim payments. Working throughout the life cycle.
• Knowledge of cost sharing options and terminology experience such as: co-pay, co-insurance, out of pocket maximums
• Conducted a Post Acute Care project for a client in order to verify patients discharge status
• Collected $75,000 in bad debt from previously denied Medicaid, Medicare and third party insurance payments through persistent follow-through and thorough ADR review. Provided insurance companies with the documentation needed to repeal prior “deny” decisions.
• At client sites, facilitated department’s day-to-day activities with other hospital departments and physicians\' offices as required to meet current departmental reviews such as meeting deadlines and keeping work-flow productivity uninterrupted
• Worked primarily as an analyst to performed health care payment and regulatory research, financial data analysis and compilation, unpaid account follow-up and resolutions, client training, operational reviews for improved internal control and overall performance, and other financial consulting projects for Hospital Clients.
• At hospital client’s site, provided ongoing training to staff on details of insurance submissions, codes and intake procedures to minimize rejections on claims submission
• Reviewed 2010 Office of Inspector General Work plan to incorporate into a compliance audit tools formats for clients.

Confidential,Carlsbad CA 6/2008-5/2009 Assistant Nursing Home Administrator

• Developed and implemented departmental policies and procedures that govern the use of patient health information. Monitored and ensured excellent customer service is provided to all residents. Help maintained all Resident records in compliance with Federal and State regulations and report inaccurate to Director of Nursing and Administrator.
• Selected Contributions:
• Manage chart review and audits for Clinical Pertinence and Utilization Reviews for compliance purposes and organize proper retention of records, files and reports in accordance with hospital and regulatory standards
• Manage productivity and audit reports, perform work-flow analysis to ensure efficiency in nursing staff productivity and weekly review patients Medical Record for accuracy and completion from Admission to Discharge according to the Federal and State Regulations.
• Helped raise state survey to “superior” rating with zero deficiencies. Resolved issues with residents’ documentation process and ensured all paper health records are in compliance with Federal, State and facility regulatory standards.
• Worked on annual budget and presentations to board of directors, resident council and all residents to better understand the facility’s upcoming fiscal year and compliance with Medicare cost reports
• Marketed agency’s new Alzheimer’s program and unique quality-of-life features that resulted in facility tour requests and increased census by 9.2 percent.
• Built mutually respectful relationships with third-party payers, Medicare, Medicaid, private payers and independent commercial carriers.
• Directly involved with general management of hospital, attended meetings, planned short-term and long-term goals, and conducted facility rounds to obtain first hand information on how facility can improve.

Confidential,Towson, MD 2007-2008
Internship

• Performed administrative, operational and technical assignments to receive on-the-job exposure to healthcare issues and residents.
• Observed various departmental tasks such as workers compensation, medical charts organization, budgeting, environmental inspections, marketing, nursing care plan and variety of potential cost-benefit ideas.
• Observed department heads in becoming familiar with facility operations.

SKILLS

Microsoft Access Database
HIPAA Regulations
Insurance Reimbursement/ Collections
Medicare/Medicaid Reimbursement
Current Procedural Terminology (CPT) & International Classification of Diseases (ICD-9)
Data capture in the EHR

AFFILIATIONS

American Health Information Management Association (AHIMA)
American Academy of Professional Coders (AAPC)
Project Management Institute (PMI)