Senior Business Analyst (Enrollment Specialist) Resume

SUMMARY:

Results oriented leader with proven success in healthcare revenue cycle management seeking operational position in collections and EDI. Strong insurance and self - pay collection experience covering DME, inpatient/outpatient, physician, nursing home, skilled, and orthopedic collections; experience with Medicaid, Medicare, non-traditional Medicare (MCO), and commercial payers; Strong EDI (835, 837, 277, 999) payer enrollment and trading partner agreement experience with multiple clearinghouses.

PROFESSIONAL EXPERIENCE:

Confidential

Senior Business Analyst (Enrollment Specialist)

Responsibilities:

Researched various clearinghouses determining free sftp connections, enrolled specified HCA facilities (NPI) for EDI 835 payer and Electronic Funds Transfer (EFT) agreements; assisted developers with sftp and receiver ID setups; worked in-house proprietary software applications, and external applications

Confidential

EDI Analyst

Responsibilities:

Worked DME-- EDI 270/271; 835/837, 277, 999 transaction files for billing and collections for identification of claims transmission, denials and duplicates; worked in-house proprietary software applications

Confidential

Collections Representative

Responsibilities:

Collection follow-up on Medicaid, Medicare replacement, and commercial accounts, reviewed denials and submitted for modifier review and appeal; NexGen and Gateway experience.

Confidential

Assistant Project Manager

Responsibilities:

Coordinated satellite business office for 21 nursing and rehabilitation facilities, recruited and trained staff of 13, organized operations and workflows, supervised employees, coordinated billing and follow-up of submitted claims to insurance companies, submitted and monitored general journal adjustment entries to accounting, submitted and recommended bad-debt write-offs to management, reported weekly to management.

Confidential

Insurance Verifications/Collections Supervisor

Responsibilities:

Assumed supervision of 23 additional employees for internal/external customer service dedicated to Sales support using both electronic and manual verification tools; responsible for the development of the verification team - script writing, facilitation, evaluations, teaching, coaching, time and conflict management, team building, resource development; maintained call center monitoring to maintain a high level of customer service in conjunction with Confidential .

Confidential

Collections Supervisor

Responsibilities:

Created and developed Collections Department with staff of nine.
Developed collection policies and procedures; monitored representative’s incoming/outgoing phone calls to ensure a standard of high quality customer service and compliance with departmental, state, federal guidelines; maintained monthly collection goals on average receivables; managed bad write-offs; managed the Financial Assistance Program.

Confidential

Medicare Collector/Financial Counselor/Patient Account Representative

Responsibilities:

Maintained Medicare Receivables, follow-up on unpaid claims over 30 days, refer bad-debt accounts to collection agency, discussed patient balances and negotiated arrangements on self-pay accounts, limited bi-lingual financial counseling on self-pay accounts.

Confidential

Substitute Teacher

Responsibilities:

Replaced regularly assigned teachers daily, executed outlined lesson plans, introduced new subject matters, assisted students, performed other duties as requested by teacher or principal.

Confidential, Nashville, TN

Collector/Insurance follow-up

Responsibilities:

Contacted insurance for payment on claims greater than 30 days, collected outstanding patient balances when appropriate, recommended accounts for bad debt, placed bad accounts with collection agency or attorney, responded to patients, insurance, and physicians regarding account concerns; used medical records to verify charges and services; prepared refund requests, interacted with billers for claim corrections, identified secondary claims for processing, developed collection policies and procedures, monitored accounts for payment according to fee schedules.

Confidential, Nashville, TN

Collector

Responsibilities:

Responsible for collection of self-pay and insurance accounts for 54 hospitals, determined accounts

Confidential, Nashville, TN

Patient Access Manager

Responsibilities:

Responsible for registration of Central Admitting, Emergency Room, Cancer, and Laboratory departments; other responsibilities included scheduling, insurance verification, and financial counselors.
Developed and documented departmental policies and procedures; responsible for upfront collections, registration quality and assurance, document imaging, interviewing, hiring,, budget.

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