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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, Saint Louis, MO.

Fraternity: Delta Epsilon Chi

Society: DECA Collegiate

Associate of Arts:Business Administration & Management2011St. Louis Community College, Meramec, Kirkwood, MO.GPA: Dean's List

Dean's List

High School Diploma:College Prep/Business2009Hazelwood Central High School, Florissant, MO.

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
  • Accounts Payable/Receivable
  • Business Development
  • Charge Entry
  • Claim Adjudications/Appeals/Denials/Write Offs
  • Communications
  • Call Center/Customer Service
  • Financial Auditing/Reporting
  • Insurance Verification
  • Leadership

  • Managed Care
  • Medical Billing
  • Quality Improvement
  • Relationship Management
  • Revenue Management
  • Strategic Methodology
  • Team Building
  • Third Party Reimbursement
  • Utilization Management
Experience
BJC HealthCareSaint Louis, MO.Reimbursement 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.
Enterprise Holdings EAN Services LLCSaint Louis, MO.Call 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.
ConvergysArnold, MO.Team 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.
MercyChesterfield, MO.Account 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

Companies Worked For:

  • BJC HealthCare
  • Enterprise Holdings EAN Services LLC
  • Convergys
  • Mercy

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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