Claims Management Analyst Resume Profile ,SC - Hire IT People

Summary of Qualifications: Steady progression in training, learning and management over the past 20 years of employment. Experience delivering training and information to peers and senior management. Experience with interpreting data. Proficient with several medical billing software programs. Proficiency in computer usage, email and MS office suite. Certified coder for 6 years. Proficient with use of ICD 9, CPT 4, HCPCS, physician billing, ambulatory surgical center billing. Experience with developing and implementing department goals. Adapt well to fast paced environments and setting priorities. Ability to manage and complete projects with tight deadlines.

Employment: Confidential Central Billing Office Manager Responsible for the daily management of staff Review of productivity of staff Review daily processes of staff and computer system Educate Medical Director and physicians with coding changes and errors Establish standard operating procedures for the billing department Other duties as necessary to ensure proper reimbursement for services Confidential Office Manager Responsible for the daily management of staff Accounts Payable Human Resources Staff and Physician payroll Physician credentialing Responsible for overseeing Accounts Receivable, front desk operations and training Initiated use of MacPracticeMD for physician billing and set up of EMR for the practice, training of staff on use and abilities of software Palmetto Health Physician Practice Billing

Confidential Claims Management Analyst Responsible for the accurate and timely processing of clearing house rejected or invalid claims Responsible for adding insurance carrier information for system claim processing Creation and updating of accurate and useful information Ensure and drive best practice standardization Ensure correct ANSI formatting for all billing groups Assist AR staff with claim processing determinations Resolves coding and coding documentation issues with coding department Collaborate with system trainer for functional operation of McKesson Practice Plus Assist Operations Department Interpretation of data analytics Confidential Business Office Consultant for Temp Assignment Establishing durable process for billing and collection of residential and acute care claims Responsible for processing outpatient insurance claims for treatment of mental health Obtain Medicaid and Department of Mental Health authorizations Confidential Business Office Manager Responsible for supervision, training and performance of 12 employees Resolve patient concerns Accurate reporting of insurance denials and appeals Responsible for computer operations and problem solving Staff education regarding new insurance requirements, rules and regulations Responsible for oversight and coordination of all physician coding and documentation Provides coding and compliance support to physicians and staff Identify and assess compliance risk Confidential Billing Manager Assist complete computer billing system implementation Train all staff employees on phone and computer billing systems Responsible for all insurance, patient billing and collection Posting and coding all surgical procedures for 4 surgeons Responsible for all computer operations, upgrades and correction of minor system problems Training and coaching of front office personnel Create and implement office forms Audit and resolution of discrepancies Confidential Billing Manager Supervision of front office Performs all insurance claim processing and patient billing Responsible for patient collections Create and implement office forms Codes and audits for compliance Resolution of insurance denials and appeals Confidential Supervisor Insurance and billing Daily billing to patients and insurance companies Follow up of insurance denials Patient questions Responsible for operation and routine maintenance of Misys PM system Assisting staff members as needed Confidential Supervisor insurance and billing Confidential Insurance and Billing Coordinator Confidential Insurance and Billing Coordinator Filing of claims to probate court to collect balances owed by estates Backed up front desk position as needed Confidential Government Insurance Supervisor Managed all claims and charges for TRICARE, Medicare, Medicaid, VA and Worker's Comp Confidential BCBS from workflow and finishing with a position as a Special Inquires clerk in the TRICARE Division. I have acquired the necessary skills of medical terminology, 10-key calculator, benefit determination, coordination of benefits, claim processing, Misys PM, Misys Tiger, Compusystems and Allscripts PM Software knowledge. I am a member of the Columbia Chapter of the South Carolina Medical Group Management Association. 2014 MGMA Administrator Nominee

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Claims Management Analyst Resume Profile

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