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Encounters Analyst Resume Example

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ENCOUNTERS ANALYST
Professional Summary
To work for a company where I can utilize my skills and acquire new ones
Skill Highlights
16 years in healthcare industry Claims processing and researching Knowledge of CPT-4, ICD-9, ICD-10, HCPCS, HCFA 1500, UB92 Behavioral health claims Multi-task oriented in a timely manner, positive and professional team player Knowledge of working call tracking requests Word and excel experience, 10-key by touch, QNXT and AMISYS experience PMMIS, Pend Analyzer and EMS experience
Professional Experience
Encounters Analyst Jan 2016 to Current
 Bridgeway Health Solutions － Tempe, Arizona
  • Research and problem solve pended and denied encounters.
  • Send findings to the claims department with instructions on how to resolve the encounter according to state guidelines.
  • Also, correct encounters inside PMMIS when able.
  • Gather information on an encounter edit to submit to AHCCCS for a table update in helping to resolve the encounter.
  • Work with internal departments to assist with encounter solutions in order to meet department deadlines.
  • Identify issues, related to claims processing, provider billing and systemic.
  • Suggest recommendations in eliminating issues that impact encounters.
  • Search provider's file, making sure the correct provider has been selected, according to the claim image.
  • Verify inside PMMIS, that the correct member's information is the same inside AMISYS and the claim image.
Sr. Claim Benefit Specialist Encounters Analyst Jan 2008 to Jan 2016
 Aetna － Phoenix, Arizona
  • Process encounter claims (medical, behavioral health, hospital and dental) according to state guidelines, correct encounters rejected by the state, research and problem solve rejection issues.
  • Aid in updating and maintaining encounter materials and manuals.
  • Identify and communicate issue trends related to claims processing, document correction activities.
  • Occasionally research provider contracts and benefits.
  • Provide training to new teammates.
  • Act as a SME (go to person for questions) for my team.
Sr. Billing Consultant Research and Adjustment Analyst Jan 2004 to Jan 2008
 Schaller Anderson － Phoenix, Arizona
  • Determine reason for adjustment received and corrected claims as needed.
  • Identified system and billing issues.
  • Completed adjustments as per department standards, contacted providers as needed regarding their claims.
  • Researched provider resubmission and determined if an adjustment is needed.
  • Researched provider's contracts, and member's benefits to verify if claim pulled in the correct provider and benefits.
  • Called providers as needed for information missing or incorrect on claims.
  • Maintained and exceeded production and quality standards.
Education and Training
Associates of Applied Science Degree, Business Administration/Accounting Lamson College － Tempe, Arizona Business Administration/Accounting
Financial Accounting 1 Financial Accounting 11
Associates of Arts Degree, General Studies Mesa Community College － Mesa, Arizona General Studies 3.7 (4.0
Skills
10-key by touch, Behavioral health, benefits, billing, contracts, CPT, edit, Financial Accounting 1, Financial Accounting, ICD-10, ICD-9, image, materials, excel, Word, quality, researching, Research, team player
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Resume Overview

Companies Worked For:

  • Bridgeway Health Solutions
  • Aetna
  • Schaller Anderson

School Attended

  • Lamson College
  • Mesa Community College

Job Titles Held:

  • Encounters Analyst
  • Sr. Claim Benefit Specialist Encounters Analyst
  • Sr. Billing Consultant Research and Adjustment Analyst

Degrees

  • Associates of Applied Science Degree , Business Administration/Accounting
    Financial Accounting 1 Financial Accounting 11
    Associates of Arts Degree , General Studies

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