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Technical Support Analyst Resume

OBJECTIVE

  • To secure a position as a Business Analyst within an organization to evaluate and improve business systems and processes.

PROFESSIONAL EXPERIENCE

Technical Support Analyst

Confidential

Responsibilities:

  • Effectively worked with NYSDOH, DSS(Dept. of Social Services), OMIG(Office of Medicaid Inspector General), OHIP(Office of Health Insurance Programs), OPWDD(Office for People with Developmental Disabilities)
  • Conducted post payment reviews based on edits in place, to detect any improper payments and made referrals to OMIG to recover payments
  • Analyzed and troubleshoot frontend rejection and denials for HIPAA(837P,837I,837D,278,277,276)
  • Extensively worked with ICD9 - ICD10, HCPCS, Drg, CPT codes
  • Experience working with Medicare crossover claims and APG claims
  • Worked on rollout of new updates/applications e.g. ePaces, NYTrack, JIRA
  • Worked with NYSDOH for Medicaid Policy updates
  • Conducted individual support, training, group training, Seminars/Webinars and outreach support and training events for NYC providers
  • Responsible to develop training/webinar/seminar, provider notices and provider billing manuals
  • Responsible to resolve System, functional, provider related or Billing related issues
  • Responsible to perform Medical Fraud/GJ Expert Testimony
  • Responsible to provide onsite training request from Provider, State DOH, County DSS, Referrals from CSC Management, Prior Approval completion and submission
  • Performed function role on various System development projects to improve Provider services

Business analyst

Confidential

Responsibilities:

  • Created Analytic/statistical reports of various health insurance, new, total and patient retention rate
  • Created monthly, quarterly and yearly reports for revenue by procedure type per physician and by location
  • Perform qualitative and quantitative analysis of offered services, expenditures, case volume, appeals, settlements, resubmission, and write-offs
  • Generated monthly claims reports for compliance, internal audit and business assessment
  • Conducted extensive client Business Analysis and provided suggestions best fit systems to client for migration
  • Projected ROI for client by creating documentation, presentation and provided guidance to client to choose right system/tool based on Healthcare industry experience
  • Responsible for validation and successful transition (from client side) from Lytec to Epic
  • Provided software customization to improve client’s business processes
  • Provided Go-Live support for newly implemented software
  • Participated in new administrative EPIC software training and conducted various internal one-on-one and Group training sessions
  • Updated workflow by using Agile methodology after system migration to improve efficiency and quality of care provided to patients
  • Resolved duplicate patient records in system through data merging
  • Maintained patient demographic records in database and obtained pre-certifications
  • Prepared and filed claims using Lytec and EPIC software; maintained patient insurance and medical data
  • Managed accounts receivable, collection activities, associated billing denial and follow-up/resolution within billing software
  • Responsible for the maintenance, generation and communication of patient EOBs and associated internal processes

Insurance and Billing Specialist

Confidential

Responsibilities:

  • Insurance and Billing Specialist
  • Responsible for creating and verifying ICD-9, and ICD-10, CPT codes with doctors; transcribing information onto billing slips
  • Managed filing and updates to pediatrician vaccination claims with health insurance and to NYCVFC reporting
  • Coordinated daily e-claims submission, EOB and check handling, posting payments to E-Clinical and filing appeal letters for rejected claims

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