Driven Claims Analyst experienced in all aspects of insurance billing, claims and collections. Employs high-level negotiation skills in resolving claims to the satisfaction of all involved parties. Analytical thinker and innovative problem solver.
Highlights
Microsoft Office Suite (Word, Excel, Power Point, Project, Publisher, Outlook, Access, One Note) * Process/Work Flow Documentation * User Interface Design * Use Case Documentation * Analysis Program and Development * Software Testing* Adobe Software * CSS Templates * HTML * Electronic Health Records (Support and Configuration) * Snort IDS * Wireshark * HL7 Troubleshooting * Medical Billing/Scheduling System * Helix * Practice Management Reporting * Quality Assurance
Education
UNIVERSITY OF MARYLAND, UNIVERSITY COLLEGECollege Park, MarylandExpected in 1 2014 ā āMaster of Science: - GPA:
UNIVERSITY OF PHOENIXSandy Springs, GeorgiaExpected in 1 2011 ā āBachelor of Science: - GPA:
, Expected in ā āB.S:Cyber Security - GPA:Cyber Security
Entry-level Business, Data and Technology Analyst with experience managing the development and implementation of complex data and IT projects.
Assists in clarifying business requirements, performing gap analysis between goals and existing cyber security procedures and designing process and system improvements to increase productivity, security and reduce costs.
Trained in the implementation of Analysis Program Development, Analysis and, Cyber Threat Monitoring.
Experience
1-800-Flowers.Com, Inc. - SYSTEMS SUPPORT/SENIOR DENIAL RESOLUTION ANALYST Miami, FL, 10/2012 - Current
Monitor Quality and Assurance (Q&A) and system integration testing for billing and claims processing.
Participate as a part of the support team and assist management with projects to include design, planning, development, and testing of enhancements, process improvement and new initiatives.
Create CRM Strategy and Roadmap vision to manage Data Process and Technical mapping for Denial Resolution.
Project responsibility includes70+ cycles of testing with interfaces feeding data from legacy systems and software.
Perform data analysis including production of queries, accurate and appropriate interpretation of data.
Serve as first level support for troubleshooting development issues.
Provide technical documentation and process flows for projects, existing and in development.
Als Limited - EDI ANALYST Portland, OR, 10/2011 - 11/2012
In depth knowledge of HIPAA/EDI X12 v5010 healthcare-related file formats including 820, 834, 835, 837, 270, 271, 276, and 277.
Participate in various projects as assigned to help grow revenue on the EDI team.
Assist the business with understanding the integration process and requirements.
Act as their technical resource.
Assist in the design, testing, training, and delivery of EDI's, reports and supporting documentation.
Troubleshoot failed transmissions acting as a liaison between the IT departments and resolving issues in a timely manner by simplifying complex issues and creating actionable plans.
Monitored and troubleshot system availability, security breaches, malfunctions, and configured network IPs.
Executed system backups, file restoration, system recovery, and remote mapping for billing data.
Designed and developed unit testing complex functionality for large customer care and data systems such as XML, and SQL object-oriented based applications.
Planned and directed highly technical and specialized data analyses including the development of practice management reports, UML documentation, use cases, test plans/scripts, and error log systems.
Experience with billing encounters, working claim edits and creating claims.
Understanding of provider and group hierarchy as it relates to an electronic claim file.
Troubleshot efforts of information systems analysts evaluating technical analyses.
Facilitated lab interfaces, data cleaning, data support HL7 interface support, and successfully implemented patient/lab reminder systems while remaining compliant with HIPAA regulations.
Provided regular data, distributed reports and responded to ad-hoc data report requests in a timely manner Provide technical guidance to ensure the efficiency of billing operations.
Monitored accounts for commercial, government and workers compensation by running appropriate reports to resolve claims that are not paid in a timely manner.
Identified coding or billing problems from EOBs and work to correct the errors in a timely manner.
Monitored and worked offset and high dollar accounts reports ranging from $1,000 to $150,000.
Corrected and added insurance information to bill or rebill an account.
Posted payments, missing payments, and adjustments to accounts.
Submitted request for refunds and appeals.
Skills
Adobe Software, ad, billing, interpersonal skills, CRM, CSS, customer care, data analysis, delivery, Documentation, EDI, government, HTML, IDS, information systems, innovation, insurance, interpretation, Leadership, Management Reporting, Medical Billing, Access, Excel, Microsoft Office Suite, Outlook, Power Point, Publisher, Word, network, object-oriented, process improvement, coding, Quality and Assurance, Quality Assurance, Scheduling, scripts, Software Testing, SQL, Strategy, strategic, system integration, technical documentation, Troubleshoot, Troubleshooting, UML, User Interface Design, vision, XML
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