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Account Resolution Analyst Resume Profile

TX

OBJECTIVE To secure a position as a Health Care Professional with a well-established hospital with a stable environment and opportunity for growth that will lead to a long lasting relationship.

QUALIFICATIONS

Proficient in the latest medical system EPIC. Meditech Medical Systems, E-premis Clearing House System, Medicare FISS/DDE System, Medicaid online system, Care Medic Medical system, MISYS Medical System. Microsoft Word, Excel, PowerPoint, and WordPad. Organized and detailed orientated. Self-starter, team player, attention to detail, accuracy and deadlines, strong communication, problem-solving and customer service skills. Knowledgeable of Quick Books, Access, Outlook, and Windows. Quick typist,

EXPERIENCE

Confidential

Account Resolution Analyst

  • Maintains a high level of productivity. Efficiently works in EPIC work queues such as follow up
  • Credit Balances, Consecutive, Billing Review, Late Charges, etc. Responsible for ensuring that
  • ICD-9 and CPT Codes, modifiers, condition codes, occurrence codes and bill types are compliant
  • With Medicare guidelines and federal regulations. Responsible for billing and reimbursement for
  • Assigned alphas and analyzes accounts, remittance advise to ensure correct payment.
  • Responsible for handling Medicare 72 hour claims and established follow up procedures to
  • Effectively expedite the prompt payment of claims. Route claims back to various departments
  • Coding, Charge Master, etc. when necessary when diagnosis codes and/or procedure codes are
  • Not compliant.
  • Bill claims through Emdeon clearinghouse . Review ABN Advanced Beneficiary Notice for
  • Validity add modifiers if required. Make adjustments, key clean claim, corrected claims all in
  • The Medicare/FISS system. Billed claims to Skilled Nursing Facilities and Hospice Facilities.
  • Analyzes correspondence and problems as they pertain to accounts and take corrective action
  • To ensure proper maintenance of accounts, while keeping abreast of the latest changing of
  • Federal, state and all insurance regulations and guidelines as it pertains to Medicare and
  • HIPPA.

Confidential

  • This area is responsible for all Compliance and Revenue initiative billing and
  • Follow up. The accounts are broken out based on an alpha split and assigned
  • To an Account Resolution Analyst. The Special Projects Team begins
  • Working the accounts in each project via a work list. The area is responsible
  • For follow up on the receivables associated with the type of project they are
  • Working.

Medicare Analyst

Confidential

Process and review Medicare claims into the clearinghouse file. Correct and submit bills for processing to Medicare. Bill all secondary claims to Medicare commercial claims coinsurances. Adjust Medicare claims on the FISS/DDE system. Process and review new Medicare claims. Oversee special projects as requested. I have drafted various Excel spreadsheets. Processed files from the Meditech system to excel. Make calls to various insurances companies to follow up on claims that have overdue balances. Analyze and configure credit balances on accounts. Other duties as instructed. Attended numerous teleconferences with Medicare University. Processed no-fault, liability claims, and work man's compensation claims. Processed appeals for Medicare claims. Gathered physician information and entered them into the PECOS system for Medicare.

Medicare Biller

Confidential

Oversaw billing for all Medicare inpatient and outpatient accounts. Processed the Medicare accounts on the FISS/DDE system. Processed the Medicare Secondary Payer accounts. Reviewed the UB92/UB04 for accuracy. Processed all no-fault, liability and workers compensation cases. Audited credit balances on various accounts. Analyzed medical documentation for relative claims/appeals. Trained various departments on the Medicare Secondary Payer Questionnaire.

Patient Account Representative, II

Confidential

Collected on over 30 days Medicare accounts. Verified patient's eligibility through the Medicare Common Working File. Processed Medicare appeals. Phoned various insurance companies to collect on unpaid balances. Heavy phone contact.

Patient Account Representative

Confidential

Collected on delinquent commercial insurance and self-pay accounts. Verified patient's eligibility with the Medicaid and Medicare systems. Entered referrals and insurances for new patients. Represented the company on all small claims court cases.

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