PROFESSIONAL SUMMARY:

• Self - motivated achiever with strong analytical, problem-solving, time management, decision making, and communication skills; thrive in high pressure environments, track record of streamlining processes, taking initiative, and developing strategies to increase customer satisfaction
• Detail oriented Healthcare Analyst with advanced proficiency in analysis of healthcare claim data (834, 835, and 837 file formats), HIPAA, 5010, CPT/HCPCS, and ICD-10; s trong ability to perform with minimal direction, positive demeanor, and adapt exceptionally well to change

SOFTWARE/SKILLS SUMMARY:

• Word, Excel, Project, PowerPoint, Visio, Publisher
• Project Management, Basic Programming (HTML, CSS), familiarity with BI tool Qlikview
• Databay Check, Clintegrity 360, Meditech, FISS, Confidential, PCON, Meditract, SSI, SmartIX
• Deliver advanced analytical knowledge for business operations relating to claims, provider data, member data, and clinical data; primary point of contact for 50+ member hospital analysts and vendors
• Lead onboarding of new member hospitals: test data files, train new hires/users (onsite and via webinar)
• Participate in continuous education ( exposure to SAS, Microsoft SQL Server Management Studio, Python )
• Proficient in creating basic SQL queries to identify and validate hospital and patient information within data warehouse tables

PROFESSIONAL EXPERIENCE:

Confidential

Project Manager, MPI Specialist

Responsibilities:

• Liaison for healthcare Confidential standards, formats, technical specifications and regulations, manage hospital discharge data processing, identify and provide solutions for file format issues with Claim Confidential X 12 837 version 5010, and administer updates to the data warehouse reference tables
• Lead and deliver projects simultaneously from start to finish; consistently meeting deadlines (i.e., transitioning to ICD-10, software upgrades), Subject Matter Expert for Enterprise Master Patient Index (resolving possible duplicate patient records, and identifying areas of improvement)
• Multifaceted experience in quality assurance auditing and testing, recommend/deploy approval of software defects and system enhancements, develop and maintain department processes, and Data Dictionary, lead meetings with 80+ member hospitals (discuss new state mandates and all things data)

Confidential

Application Analysts Supervisor

Responsibilities:

• Supervised/Mentored a team of system analysts, granted/audited user accesses, documented software defects, managed multiple projects with an emphasis on supporting internal staff and clinical hospital personnel for Patient Financial Services ( Confidential ) billing and collection applications
• Primary contact for performing Billing Accounts Receivable (BAR) testing and live validations to escalate and resolve system related issues accurately and timely, trained and coached new hires, developed auto compile and catch reports, and maintained system dictionaries in Meditech
• Decreased the response time of internal support ticket responses by implementing an electronic ticketing system, monitored daily system operations, created and maintained department procedures/processes, and delegated tasks to System Analysts as needed

Confidential

Analyst

Responsibilities:

• Liaison between management, clients, programmers, and vendors for Confidential tracking and issue escalation/resolution: facilitated/met with clients and vendors to review the migration changes, and performed hands on data analysis of the HIPPA 4010/5010 X12 Confidential Transactions
• Established Confidential test plans, timelines, implementation target dates to ensure successful integration, examined test files and communicated results with precise solutions for solving file format issues, and completed compliance checks in Confidential Transaction Management against 834 file data
• Delivered project status reports weekly to executives and stakeholders, led conference calls, created and maintained trading partner information for set up, and provided support to management and staff as needed

Confidential

Project Administrator

Responsibilities:

• Advised and supported executives in the administration of projects involving business change mandates, system enhancements, contract directives, analysis of operating procedures, quality control activities, strategic planning, performance monitoring, and workshops with internal/external entities
• Led the resolution of escalated Electronic Data Interchange issues, coordinated and performed testing with Claim Confidential X 12 835 and 837 versions 4010; partnered with healthcare payers to implement electronic data interchange solutions for claims processing
• Investigated fraudulent account information, processed provider enrollment applications, analyzed/compiled data for the Administration Simplification Compliance Act, developed work procedures, trained new hires, and supported the executive team as needed

Claims Analyst, Financial Analyst, Overpayment Specialist

Confidential

Responsibilities:

• Increased customer satisfaction by meeting or exceeding department level benchmarks for productivity and quality by accurately processing claims, voids, and adjustments; managed the monthly check maintenance functions, including refunds, and stale date review transactions
• Enhanced the email inquiries response time by suggesting an automated email generate informing customer’s their inquiries were received and when to expect a response versus someone manually monitoring a folder periodically
• Oversaw and settled all overpayment and underpayments changes for account adjustment corrections, developed financial reports to ensure accurate billing and reporting, researched daily credit balance accounts, and supported management and staff as needed