Claims Supervisor Resume Staten Island, NY - Hire IT People

SUMMARY

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.

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE

Confidential, Staten Island, NY

Claims Supervisor

Responsibilities:

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

Responsibilities:

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

Billing Manager

Responsibilities:

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

Responsibilities:

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

Responsibilities:

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