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senior reimbursement analyst resume example with 11+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary

Efficient Reimbursement Specialist with solid background proactively managing claims and preventing insurance issues. Competent in keeping records accurate and current and proactively managing account problems. Excellent customer relations skills combined with analytical approach to handling routine and complex delays.

Skills
  • Knowledgeable of Medical Terminology,UB-04, EOB, Remittances, CPT, HCPCS, Revenue code, ICD coding, LCD/NCD guidelines, MUE and CCI edits
  • Solid verbal and written communication skills
  • Thorough knowledge concerning patient confidentiality to include governmental and HIPAA mandated regulations
  • Strong grasp of variety of claim processing rules and guidelines
  • Contract System Updates
  • Discrepancy Resolution
  • Contract System Updates
  • Medical Billing and Collections
  • Customer Service
  • MS Office
  • Multitasking Abilities
  • Critical Thinking
  • Problem-Solving
  • Medicare and Medicaid insurance
  • Commercial and Worker's Compensation insurance
Work History
Senior Reimbursement Analyst, 04/2016 - 12/2019
Atrium Health Charlotte, NC,
  • Responsible for overseeing all contracts in contract management system
  • Ensured accuracy of various reimbursement methodologies for managed care and government contracts
  • Exercised critical thinking in analyzing, identifying, and resolving reimbursement issues and communicated financial impact to leadership
  • Oversaw and assisted with reimbursement issue resolution by researching plan specifics and applying plan contract, state, or other regulations as appropriate to ensure account balances were appropriate
  • Assisted with revenue analysis and explanations and ensured discrepancies were resolved prior to month’s end
Accounts Receivables Specialist, 06/2015 - 03/2016
Carl Zeiss Vision Montgomery, MI,
  • Managed day-to-day collection activities for a portfolio of business customers with accounts receivable balances ranging from $8 million to $18 million
  • Contacted customers and or their representatives (account executive, agency, designated contact) via phone and email to resolve past due accounts receivable
  • Negotiated mutually acceptable payment arrangements as needed and verified compliance with these arrangements in a timely manner
  • Accurately documented comments and actions on customer accounts to ensure good tracking and history in system records
  • Facilitated resolution of disputed balances and discrepancies through follow up and/or reconciliation
  • Sent out customer statements, invoices and distributed aging reports as needed
  • Monitored customer accounts for non-payment, late payment, and other irregularities
  • FolClaired up, collected and allocated payments
  • Processed adjustments, charge-offs and refunds in a timely manner as needed
  • Consistently reduced A/R collections each quarter
Insurance Reimbursement Specialist, 03/2011 - 03/2015
Sonova Burleson, TX,
  • Performed reimbursement functions with emphasis on collections through complete and accurate billing
  • Worked on aged claims and identified improper payments, improper claim denials, billing errors and discrepancies on all returned claims until final resolution was obtained
  • Corrected errors by resubmitting corrected or rejected claims, including corrections to ICD-9,HCPCS, addition of modifiers, medical records, appeals, and other documentation required for timely payment
  • Prepared, reviewed, and analyzed reports that identified coding errors and payer trends
  • Documented billing, follow-up and/or collection steps and any actions taken to resolve the assigned account
  • Consistently met and exceeded all productivity targets
  • Carried out day-to-day duties accurately and efficiently
  • Used critical thinking to break down problems, evaluate solutions and make decisions
Emergency Department Charge Lead, 01/2008 - 03/2011
Florida Hospital City, STATE,
  • Successfully collaborated with nursing staff to ensure smooth flow of work and patients in the emergency department
  • Managed team of employees on 2nd and 3rd shift, oversaw their training and professional growth
  • Collected and entered all necessary demographic, clinical, billing and insurance information from patients or guarantors
  • Verified insurance eligibility and benefits and ensured all notifications and authorizations were completed within the prescribed timeframe
  • Monitored, reviewed, and resolved issues with patient accounts on assigned reports
  • Performed quality audits and looked for opportunities for process improvement
  • Identified and accepted required payments, including copayments, coinsurance and deductibles
  • Identified opportunities to improve patient relations and reduce registration processing
  • Assisted in implementing coaching classes for team members to maximize collection opportunities.
  • Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
  • Participated in team-building activities to enhance working relationships amongst different departments
  • Exceeded goals through effective task prioritization and great work ethic
Education
Associate of Science: Computer Information Technology, Expected in 05/2022
-
Valencia College - Orlando, FL,
GPA:
Status -

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Resume Overview

School Attended

  • Valencia College

Job Titles Held:

  • Senior Reimbursement Analyst
  • Accounts Receivables Specialist
  • Insurance Reimbursement Specialist
  • Emergency Department Charge Lead

Degrees

  • Associate of Science

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