Encounters Analyst Resume Example Bridgeway Health Solutions

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
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 AnalystJan 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 AnalystJan 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/AccountingLamson College － Tempe, ArizonaBusiness Administration/Accounting

Financial Accounting 1 Financial Accounting 11

Associates of Arts Degree, General StudiesMesa Community College － Mesa, ArizonaGeneral 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

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

Encounters Analyst Resume Example

Resume Score: 100%

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