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Charge Master Analyst Resume Example

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JC
Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Professional Summary

Experienced ChargeMaster Analyst with over 13 years of experience in Healthcare. Excellent reputation for resolving problems and driving overall operational improvements.

Skills

Chargemaster/Revenue Integrity Analyst for a Healthcare system that's made up of 90 Hospitals and Medical Centers, with 8 emergency rooms.

Proficient in various systems and applications such as Cerner, MedAssets , Nthrive, McKesson, and other healthcare systems.

Problem resolutions ability

Proven patience and self-discipline

Working Knowledge of CPT/HCPCS/Revenue Codes

Working knowledge of medical terminology and abbreviations, and health care nomenclature and systems

Working knowledge of the content and application of published health information management coding conventions, e.g., as referenced in "Coding Clinics" and/or other nationally recognized coding guidelines

Performs daily maintenance of the EAP chargeable database. Prepares exports and imports of the EAP database and data couriers activities. Performs all charge testing activities for New Department builds

Working knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement

Computer skills using Microsoft Office, Excel, Works, Powerpoint, and Internet knowledge.

Work History
09/2016 to Current Charge Master Analyst Carillion Health System | Wytheville, VA,
  • Responsible for performing CDM audits with a focus on accuracy, maintaining compliance with regulatory agencies and assisting facilities with charge capture, billing and compliance issues
  • Provides decision support to clinical departments and other customers regarding pricing, CDM concepts, HSCRC methodology and select reimbursement concepts
  • Add, delete, and change descriptions for codes annually per guidelines within the chargemaster.
  • Preform assigned audits by researching documentation, analyzing information and making recommendations to improve flow of claim and apply corrections as needed.
  • Monitor and assist with department charge reports.
  • Provide support to departments regarding corrections to rejected charges and adding late charges.
  • Analyzes bills to ensure reimbursement is maximized by using UB revenue codes and CPT/HCPCS/ICD_9 codes per payer specifications/contracts.
  • Prepare annualized cost reports for review for possible price changes and the potential operational revenue impacts.
  • Participates in charge validation testing related to new system implementations and / or existing clinical / financial system upgrades. Responsible for maintaining detailed work papers and reporting results of charge validation testing to Department Manager
  • Working knowledge of multiple healthcare applications, including but not limited to Cerner Revenue Cycle, Cerner Patient Accounting, NThrive CDM Master, NThrive Contract Manager, HBI, MedAssets, and Other CDM maintenance software.
10/2014 to 09/2016 Authorization Specialist Bend Memorial Clinic | Raritan, NJ,
  • Collected and processed patient liability statements prior to service.
  • Created and maintained spreadsheets detailing all medical procedures, including applicable denials and approvals.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Researched denied claims and contacted insurance companies to resolve these issues.
  • Maintained compliance with patient privacy and security regulations.
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Reached out to insurance carriers to obtain prior authorization for testing and procedures.
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Collaborated with Financial advisors to process patients lacking coverage for planned procedures.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Tracked referral submission during facilitation of prior authorization issuance.
  • Authorized oncology and radiology requests in accordance with applicable plan guidelines.
  • Communicated with executives about consistent customer issues.
  • Edited letters and written material for correspondence.
  • Resolved conflicts and negotiated mutually beneficial agreements between parties.
  • Drove operational improvements which resulted in savings and improved profit margins.
08/2006 to 10/2014 Patient Financial Specialist Banner Health | Tempe, AZ,
  • Located errors and promptly refiled rejected claims.
  • Trained new employees on multiple medical billing programs and data entry software.
  • Posted and adjusted payments from insurance companies.
  • Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
  • Communicated effectively and extensively with other departments to resolve claims issues.
  • Accurately posted surgeries, hospital visits and payments for assigned carriers.
  • Responded to requests for information from various individuals by providing requested documents.
  • Precisely evaluated and verified benefits and eligibility.
  • Accurately posted and sent out all medical claims.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
Education
Expected in 05/2014 Bachelor of Science | Organizational Leadership Bethel University , McKenzie, TN , GPA:

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Resume Strength

  • Length
  • Personalization
  • Target Job

Resume Overview

School Attended
  • Bethel University
Job Titles Held:
  • Charge Master Analyst
  • Authorization Specialist
  • Patient Financial Specialist
Degrees
  • Bachelor of Science

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