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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 AnalystJan 2016 to Current
Banner Health - Fort Collins , CO
  • 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 AnalystJan 2008 to Jan 2016
Aetna - City , STATE
  • 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 AnalystJan 2004 to Jan 2008
Schaller Anderson - City , STATE
  • 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/AccountingLamson College - City, StateBusiness Administration/Accounting
Financial Accounting 1 Financial Accounting 11
Associates of Arts Degree, General StudiesMesa Community College - City, StateGeneral 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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DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

How this resume score could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

60Fair
Resume Strength
  • Completeness
  • Formatting
  • Word choice
  • Length
  • Strong summary
  • Clear contact info
  • Typos

Resume Overview

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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