Claims Analyst Resume

Objective: Utilizing my health information knowledge, business skills, leadership capabilities, communication skills, technical skills, and decision-making qualities.
Education: Confidential University
Bachelors of Science Degree Major: Health Information Management
Certification: Register Health Information Management Eligible/In Process

Employment:

Confidential
2007-2012 Member Benefit Analysts

Review new and old transmittal for company compliance
Quarterly review, design, and update to Facets of new CPT, HCPCS, and Diagnosis codes and all associated activities related to new codes.
Enter into the system invalid modifiers with procedure codes to generate system denials
Design, upload, import, and export fee schedules
Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules.
Create new, update old, or terminate physician agreements

Claims Analyst

Accurately entered billing data
Serviced past due accounts
Priced Dual Medical Equipment claims
Analyze and manually price all Pharmacy (listed and unlisted) codes.
Review authorizations to correctly indentify provider’s authorizations request.
Review pended claims report, queues, and process claim for payment.
Enter COB and performance maintenance of information including carrier name, policy number, and effective/termination dates within system.
Adjusted, corrected, and released claims
Communicate with management regarding claims/system issues and potential process improvement.

2008-2011 Confidential
(Part time) Instructor Dayton, Ohio

Instructor for ICD-9 Coding
Instructor for Billing

2006-2007 Confidential
(Contract) Medical Billing and Coding Dayton, Ohio

Place codes into computer system and sent out HCFA 1500 forms/UB 92 Forms for payment.
Charge/Data Entry also Completed Monthly Reports
Work accounts receivable
Billed Medicare, Medicaid and any Third Parties Payers

Knowledge & Skill

DRG and APC reimbursement methods -CPT, HCPCS, ICD-9 -HIPAA Transaction Codes
Facets system knowledge/training -SQL knowledge -Enhanced communication skills both written and verbal
Knowledge of Medicaid/Medicare -years of claims processing skills -Close attention to detail with time management skills
Decision-making and problem solving skills -Research root cause analysis skills -Knowledge of billing practices -Proper grammar usage -Time management skills -Proper phone etiquette -Medical terminology -Customer service oriented
Advanced computer skills within Microsoft Word, Excel, Access and Visio.

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