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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