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market revenue integrity analyst resume example with 13 years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Summary

Well-organized and detail-oriented RI Analyst with key experience in Healthcare environments. Knowledgeable about overseeing agreements, enforcing policies and optimizing procedures for dynamic requirements. Focused on maintaining consistence, quality and compliance in all areas. Results driven Medical Coder with over 10 years of hands-on experience in account management, revenue generation and medical billing and coding. Accomplished in developing strategies to improve workflows and processes, and actualizing procedures to enhance revenue generation. Demonstrated leadership skills guide teams towards success, optimize performance and sustain organizational success. Successful health information professional accomplished in maintaining complex and comprehensive records systems. Enhanced operations by identifying and recommending upgrades. Fully versed in medical terminology and code classifications.

Skills
  • HIPAA Compliance
  • Compliance Reviews
  • Insurance Knowledge
  • Auditing proficiency
  • Account updating
  • Revenue forecasting
  • Quality control
  • Customer relations
  • Trained in HPF and MEDITECH
  • Multitasking
  • Medical terminology
  • Data entry
  • Medical auditing
Experience
05/2021 to 07/2022 Market Revenue Integrity Analyst Sea Mar Community Health Centers | Western Washington, WA,
  • Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
  • Resolve patient telephone inquiries regarding billing/patient care issues.
  • Perform corporate mandated billing compliance audits on federal payors and report quarterly to the Ethics & Compliance Committee.
  • Perform division mandated billing compliance on EPO administration and report findings to the division office.
  • Facilitate hospital departments with charge capturing and charge review in compliance with corporate correct coding initiative.
  • Provide monthly denial log review identifying issues for corrective actions.
  • Followed NCD/LCD guidelines and educated the necessary departments.
  • Process daily Trauma charges
  • Process monthly Trauma stats
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Communicated with healthcare personnel, including practitioners to promote accuracy.
  • Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Acted as liaison between business department, billers and third party payers in resolving billing and reimbursement accuracy.
  • Verified accuracy of information and resolved discrepancies with vendors before entering invoices for payment.
  • Participated in workshops, seminars and training classes to gain stronger education in industry updates and federal regulations.
  • Performed insurance verification, pre-certification and pre-authorization.
  • Developed strong professional rapport with vendors and clients.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Coordinated communications between patients, billing personnel and insurance carriers.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Collaborated with clinical departments to generate accurate and compliant charges.
  • Charge Master Anaylst
02/2012 to 05/2021 Charge Capture Compliance Officer/Case Spotsylvania Regional Medical Center | City, STATE,
  • Support division office in handling patient complaints.
  • Resolve patient telephone inquiries regarding billing/patient care issues.
  • Complete administrative adjustment authorization form for administrative approval on patient accommodations.
  • Perform corporate mandated billing compliance audits on federal payors and report quarterly to the Ethics & Compliance Committee.
  • Perform division mandated billing compliance on EPO administration and report findings to the division office.
  • Facilitate hospital departments with charge capturing and charge review in compliance with corporate correct coding initiative.
  • Provide monthly denial log review identifying issues for corrective actions.
  • Handled support tasks such as office supplies and meeting schedules to support senior case managers with workloads.
  • Built and maintained strong relationships with patients by successfully resolving issues and responding promptly to phone inquiries.
  • Educated patients on various resources, services and programs to maximize care.
  • Observed safety protocols to minimize accidents and spread of disease.
  • Collaborated with social workers/RN case managers to support patients.
04/2010 to 02/2012 HIMS Analyst Spotsylvania Regional Medical Center | City, STATE,
  • Pulled patient records and transferred information to appropriate parties.
  • Disseminated information to correct department, individual or outside location.
  • Verified record copies before handing each over to check for and remove unnecessary details.
  • Set up patient charts and documented information in various company software.
  • Determined and implemented techniques to improve medical records retrieval process.
  • Streamlined day-to-day office processes to meet long-term goals.
  • Provided respectful assistance to all parties, including patients, staff members and insurance company representatives.
  • Juggled multiple projects and tasks to ensure high quality and timely delivery.
07/2009 to 04/2010 Medical Receptionist ENT Of Fredericksburg | City, STATE,
  • Answered phone calls to provide assistance, information and medical personnel access to maximize office efficiency.
  • Scheduled and followed up on patient appointments, collected and processed patient payments and maintained patient files.
  • Straightened up waiting room to maintain neat and organized space.
  • Entered patient information, including insurance, demographic and health history into system to keep all records up-to-date.
  • Pleasantly greeted each patient and offered the desk sheet for easy sign-in.
  • Observed strict HIPAA guidelines at all times according to company policy.
  • Processed patient payments and scanned identification and insurance cards.
  • Took messages from patients and promptly relayed to appropriate staff.
  • Communicated with all partners throughout practice, including physicians, nursing staff, technicians and medical assistants.
  • Informed patients of financial responsibilities prior to rendering services.
Education and Training
Expected in 04/2009 to to Certificate | Billing And Coding Eastern Virginia Career College, Fredericksburg, VA GPA:

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Resume Overview

School Attended

  • Eastern Virginia Career College

Job Titles Held:

  • Market Revenue Integrity Analyst
  • Charge Capture Compliance Officer/Case
  • HIMS Analyst
  • Medical Receptionist

Degrees

  • Certificate

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