- A Business/Systems Analyst position, in which a broad background in healthcare claims and systems, along with strong problem - solving skills will contribute to the efficient provision of health care.
- Seasoned health care claims professional and analyst with 18+ years of experience from various healthcare perspectives - from software vendor to provider to payer - with a well-balanced combination of business knowledge and analytical skills, with the proven ability to manage projects toward the successful achievement of goals.
- Case Trakker
- Horizon Products
- McKesson (STAR)
- Monarch ePREMIS
- Crystal Reports
Confidential, Staten Island, NY
- Manage staff of 10 to ensure claims are processed accurately, within Medicare and Medicaid regulatory timeframes and individual performance goals while adhering to department, industry and productivity standards
- Oversaw Claims Call Center unit for the effective fielding and resolution of all provider calls regarding claim issues.
- Schedule daily work assignments and assists staff in the solution of problem claims.
- Develop indicators, monitoring tools and reporting mechanisms to support all areas of the claims department
- Review and analyze weekly and monthly department performance reports.
- Escalates department performance issues and recommends or implements needed interventions
- Handle escalated claim related complaints.
- Communicate with the appropriate parties to obtain and impart invoice data to resolve problem claims.
Confidential, Paterson, NJ
Medical Billing Manager
- Managed staff of 2 to complete patient registration and all Dermatology reimbursement activity for Medicare, Medicaid and commercial insurance including coding, sending claims to the clearinghouse, payment posting and denial management
- Managed KPI’s
- Updated physicians and mid-levels regarding coding and modifier issues
- Managed staff and assignments
- Educated and assisted physician practices transitions to ICD-10
- Managed HIPAA compliance as HIPAA compliance officer
Confidential, Elizabeth, NJ
- Managed staff of 2 to complete patient registration and all Dermatology reimbursement activity for Medicare, Medicaid and commercial insurance including coding, sending claims to the clearinghouse, Managed staff of 2 billers/collectors
- Managed all reimbursement activity for Medicare, Medicaid and commercial insurance including auto insurance and worker’s comp cases
- Organize and travel to meet with clients on-site to review patient registration, billing, coding, etc. to improve processes
- Billed/collected for a variety of specialties, including general/vascular surgery, orthopedic surgery, wound care, etc.
- Managed the purchase, installation and maintenance of Medical Billing system and EMR’s
- Produce Gap Analysis, Process Analysis, Impact Analysis reports
- Create RFQ’s, review and recommend software systems
- Analyze provider contracts with Insurance companies
Confidential, Newark, NJ
Physician Billing Director
- Managed the purchase, installation and maintenance of Medical Billing system
- Prepared and managed budget
- Ensured that infrastructure technology, finance, human resources, legal, and facilities - cohesively drive and support the implementation of our services
- Analyzed reports (CPT, Aging, etc.) and operations to leverage resources to successfully deliver services with high customer satisfaction and increased profitability
- Managed all reimbursement for Medicare, Medicaid and commercial insurance including initial claim, follow up, appeals, and secondary insurances
- Lead and mentored staff of 5 in finance, human resources, outcomes measurement, and sales
- Accountable for division’s profit and loss
- Negotiated contracts
- HIPAA compliance experience
Confidential, Secaucus, NJ
Senior Systems Analyst
- Implemented, upgraded and maintained HPF (Electronic Medical Record), HBF (Central Business Office System) and ED Tracking Board
- Managed workflow analysis, COLD templates, 835 and 837 files and HL7 transactions
- Monitored the product/program/project from initiation through delivery, interfacing with customer on technical and non-technical matters.
- Coordinated all aspects of project and served as project manager between internal clients and vendor
- Resolved issues and documented processes
- Supported and upgraded STAR Patient Accounting system, Budgeting, Charge Master and Cost Accounting
- Designed, Created and Modified ad hoc and project based analysis reports to assist senior management in making strategic decisions in a multi hospital environment (billing, budget, tracking, census, profitability, variance, statistical, etc.)
- Presented reports using Access, Excel, Crystal Reports and SQL
- Documented procedures, problems and solutions
- HIPAA compliance experience
- Attended user group meetings