Reimbursement Analyst/ Revenue Cycle Management Resume Burlington, NC - Hire IT People

SUMMARY:

To obtain a position that will allow me utilize my analytical skills, problem solving abilities, and 14 Years of experience in the health care industry.

TECHNICAL SKILLS:

SKILLS PROFILE: Health care, managed care, revenue cycle management, leadership, HIPPA, customer service, fundraising, marketing, public relations, appeals, health insurance, claims, Microsoft Office Suite, analysis, accounts receivable, accounts payable, credit balance, denial trends, medical policy, medical terminology, project management, contract language interpretation and process improvement.

SOFTWARE: Microsoft Office Suite, Siebel, Power MHS, Siemens, Document Direct, Razor, Lotus Notes, Crystal Reports and SAP Business Objects.

EMPLOYMENT HISTORY:

Confidential, Burlington, NC

Reimbursement Analyst/ Revenue Cycle Management

Responsibilities:

Perform root cause analysis on healthcare payer denials to reduce accounts receivables of $9M.
Provide weekly financial analysis of payers’ including variance and impact analysis.
Perform analysis on data by utilizing MS - Excel, SAS, Business Objects, and Crystal Reports.
Create project plans and lead change initiatives via cross functional teams and departments.
Develop work flow processes per compliance and federal regulations.
Create and update Standard Operating Procedures ( Confidential .'s) as needed.
Decipher contract language and medical policies to determine appropriate pricing and billing procedures.
Initiate and maintain effective working relationships with key provider contacts.

Confidential, Durham, NC

Sr. Provider Services Analyst

Responsibilities:

Responsible for supervising employees at various client sites in North Carolina and South Carolina.
Implemented team strategies for identifying credit balance recoveries and new clients.
Negotiated with provider clients on exchange of services.
Performed on-site credit balance reviews at hospitals and billing offices, recovering over payments for health plan clients and analyzing and resolving credit balances for service providers.
Processed account credits, debits, refunds, and transfers as needed.
Worked with special claims situations involving coordination of benefits and subrogation with auto insurance policies and worker’s compensation claims.
Initiated and maintained business relationships with hospital business office staff and management.

Confidential, Durham, NC

Document Control Specialist

Responsibilities:

Performed document control for surveys administered by the Centers for Disease Control ( Confidential ) in a clinical research environment.
Also worked on The Environmental Polymorphisms Study for the Confidential tracing and updating study participants.
In addition I worked on the Confidential 's Defense Medical Surveillance System project ( Confidential ) traveling to work sites for medical record abstraction in order to determine the accuracy level of the vaccine data in the Confidential database.

Confidential, Durham, NC

Operations Specialist

Responsibilities:

Responded to customer inquiries concerning health insurance benefits for groups and individuals by telephone, Face-to face interviews, and written correspondence, applying HIPPA guidelines to each customer interaction.
Utilized a working knowledge of claims processing, coding and medical terminology practices.
Coordinated with Health Benefits Representatives on administration of benefits.
Worked with governmental agencies such as Medicare, Medicaid, and NC Health Choice on billing for medical claims.
Led, trained, and developed new hires.

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Reimbursement Analyst/ Revenue Cycle Management Resume

Burlington, NC

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