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
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
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
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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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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