Reimbursement Analyst/Supervisor Resume Example
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REIMBURSEMENT ANALYST/SUPERVISOR
Professional Summary
Ambitious Reimbursement Analyst & Supervisor versed in research and analysis. Seeking a position to develop and implement new and innovative health care improvement processes and admission procedures.
Education and Training
Bachelor of Science:Business Administration & Finance2013University of Missouri, St. Louis, City, State
Fraternity: Delta Epsilon Chi
Society: DECA Collegiate
Associate of Arts:Business Administration & Management2011St. Louis Community College, Meramec, City, StateGPA: Dean's List
Dean's List
High School Diploma:College Prep/Business2009Hazelwood Central High School, City, State
Peer Leader: 2005-2009
President of DECA Chapter: 2008-2009
President of Student Council: 2005-2007
Vice President of FBLA Chapter: 2008-2009
National Honor Roll: 2005-2009
National Honors Society: 2005-2009
Skill Highlights
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Experience
Best BuyChesapeake , VAReimbursement Analyst/Supervisor05/2012 to 09/2013
- Managed individual(s) including but not limited to: hiring, training, assigning work, managing & evaluating performance, conducting professional development plans. Ensured that the productivity and actions of that group met/supported the overall operational goals of the department as established by department leadership.
- Participated in the development of departmental staffing, revenue and/or expense budgets and having direct responsibility for adhering to those goals. This included responding to changes in the business which may affect the ability to achieve the budget goals.
- Supervised the day to day operations of the department, ensuring timely billing of all product or service line accounts.
- Reviewed and makes proposal for adjustments to accounts receivable balances.
- Audited accounts with outstanding balances and approves accounts for referral to a collection agency.
- Observed & evaluated employee performance on monthly basis.
- Conducted or approved performance evaluations for all department employees.
- Reviewed & approved time cards for processing by Payroll Department.
- Approved/denied paid time off requests.
- Reviewed payments and contractual allowances.
- Performed monthly audits on aged/high dollar accounts.
- Monitored reimbursements from third party carriers as defined in contractual and federal or state agreements.
- Processed payment discrepancies and identify variances; research contract terms; perform analysis of discrepancies; initiate appeals & process refunds.
- Identified payment discrepancy patterns; propose resolution via Managed Care Payor Representatives, managed care contracting, billing processes, etc.
- Participated in regular meetings with primary Managed Care Payor Representatives. Presented payment discrepancy patterns utilizing actual claim examples.
PharmaviteCalifornia , MDCall Center Supervisor07/2010 to 01/2012
- Provided leadership in Customer Service.
- Analyzed team statistics, financial reports, & billing audits.
- Supervised team productivity, enforced company policy, & adhere to call center guidelines.
- Observed & evaluate employee performance on a monthly basis.
- Coached agents on performance based on departmental & individual metrics.
- Conducted or approved performance evaluations for all department employees.
- Reviewed & approved time cards for processing by Payroll Department.
- Approved/denied paid time off requests.
- Oversaw collection payments processed through CRI (Credit Replacement Invoices).
- Authorized method of payment change requests via RAF (Rental Adjustment Form).
- Authorized & filed complaint requests for EAN customers.
Havas EdgeBoston , MATeam Lead06/2009 to 07/2010
- Served as backup to Team Manager.
- Provided leadership in customer service.
- Trained new customer service associates.
- Handled escalated/supervisory calls.
- Participated in monthly coaching/department meetings.
- Made recommendations for performance evaluations.
MercyCity , STATEAccount Coordinator06/2008 to 05/2009
- Processed claims through E-Verify, PassPort, & WebMD.
- Followed HIPAA guidelines and regulations for confidentiality.
- Verified patients insurance accounts for validation.
- Ensured the accuracy of public information and materials.
- Actively served on Utilization Review Committee by reviewing policies, patterns of providers and sanction processes.
- Posted cash payments to appropriate accounts.
- Provided expertise in the area of patient accounts related to third party billing, customer service responses, charge entry, payment processing/reconciliation.
- Provided expertise in the area of insurance collection activities related to hospital billing for services provided.
- Provided expertise to define daily support required for the Patient Financial Services department.
- Provided implementation support at each hospital during go-live events.
Skills
- Accounting/Billing systems
- Analytical thinking
- Auditing productivity
- Claims analysis and review specialist
- Conflict resolution
- Critical thinking proficiency
- Detailed oriented
- In-depth claims knowledge
- Microsoft Suite
- Proven patience and self-discipline
- Staff training and development
- Staffing management ability
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Resume Overview
School Attended
- University of Missouri, St. Louis
- St. Louis Community College, Meramec
- Hazelwood Central High School
Job Titles Held:
- Reimbursement Analyst/Supervisor
- Call Center Supervisor
- Team Lead
- Account Coordinator
Degrees
- Bachelor of Science : Business Administration & Finance 2013
Associate of Arts : Business Administration & Management 2011
High School Diploma : College Prep/Business 2009
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