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Claims Supervisor Resume

Staten Island, NY

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

  • MCO
  • Case Trakker
  • Horizon Products
  • McKesson (STAR)
  • Medisoft
  • Excel
  • Access
  • PowerPoint
  • FRS
  • Monarch ePREMIS
  • Crystal Reports

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

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