Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Career Focus
Experienced MBA/MHA Business Analyst with 10 years of health care administration and process improvement background. Adaptable, driven team player with 3 years of supervisory experience.
Summary of Skills
Vendor Relations, Process development
Business recovery and sustainability
Complex problem resolution
Strategic planning
Data mining
Microsoft Word, Excel, PowerPoint, some Access. Pivot tables, PowerMHS 7.2, Imaging Process Design, Portico (provider contracts), Business Objects, Repository, MAGIC, BlueArt, Siebel, DocRequest, Encoder Pro, Medical coding, medical terminology and some Citrix.
Professional Experience
2012 to 08/2015Vendor Recovery AnalystCarepoint Health | , ,
Worked with third party vendors to determine financial accuracy by data mining.
Acted as a liaison between the company and third party vendors to promote a positive vendor relationship.
Made recommendations for process improvements, changes to procedures, and make necessary requests for certain items to senior management.
Assisted with developing risk analysis for financial errors made on paid claims.
Participated in the development of procedures to validate and quality check claim audits.
Worked closely with upper management to stay within proposed budget limits set for the team quarterly.
Monitored individual new- hires work to make sure that they are adhering to company policy, procedures, and team goals.
Addressed performance issues with database used to validate claims and provide appropriate feedback to the business analyst.
Completed audits on claims.
Checked figures, postings and documents for correct entry, and financial accuracy .
Protected patient rights by adhering to HIPAA guidelines.
Kept patient appointments on schedule by notifying physician of patient's arrival and reminding physician of any delays in scheduling.
Performed duties that allowed for treatment room utilization by scheduling appointments via telephone and walk-ins.
02/2007 to 2012 Operations SpecialistW.R. Berkley Corporation | , ,
Assisted SOS Management/COP team with conducting data analysis on queries that are processed daily and provide feedback to the appropriate areas.
Completed special projects that are assigned via Queries mailbox and or team lead, which may involve data collection/reporting the projects outcome.
Notified the appropriate persons of system issues, necessary policy changes, and work-flow issues.
Served as a SME/ liaison for daily queries maintained and report any issues for automation production.
Reported daily on inventory spikes or dives in query or special project work-flow.
Processed electronic, paper, and suspended claims transactions in daily/monthly assignments.
Managed internal and external claim adjustments to complete/correct prior claim transactions.
Requested refunds for over-payments, reversed claims denied in error, processes voucher/pay member deductions, prior deductible credit, non-monetary internal adjustments, and recovered monies.
Assisted management by identifying and analyzing opportunities for improvements in Plan processes, policies, and services.
Offered recommendations for new procedures for changes that would result in cost savings and more efficient processing of claims.
Provided input for Claims Business Rules Governance Team to make sure that the processes used to complete hold codes, queries, and or job aids have the correct wording to assist examiner in processing.
Assisted with QA testing and validation weekends.
05/2006 to 02/2007Claims ProfessionalEquitable Holdings,Inc, | , ,
Adjusted, researched and entered data into processing systems any missing or incorrect information on imaged or paper claim forms.
Identified and analyzed system suspend/processing problems, including documentation of the issue, identification of potential solutions, referral to appropriate technical staff, and follow-up to ensure resolution.
Provided technical assistance for State PPO front-end processors.
05/2005 to 05/2006Front End ProcessorKelly Services /Blue Cross Blue Shield Of NC | , ,
Collected data, analysis, and reporting.
Communicated with customers, providers, pharmacies, and other departments in the Plan to resolve ongoing problems with claim submission and to improve the claims process.
Kept records of system downtime, desk count, flow sheets, and daily work measurement sheet.
01/2003 to 02/2006Administrative Data Entry ClerkFed Ex Ground | , ,
Answered multi-line phones for high volume business.
Maintained strong communication skills between staff, contractors, and customers.
Conducted nightly audits, and deposits.
Proficient in web information retrieval, filing, data entry, package claims, and faxing.
Conducted routine equipment checks and inventory control procedures.
Scanned and weighed packages for correct shipping and billing purposes.
Made sure the clients were satisfied by the contractors' delivery/service.
Education
Expected in 2013Master's Degree | Business AdministrationPfeiffer University, Misenheimer, NCGPA:
Dual Masters in Business Administration and Health Care Administration
Study abroad, France and Germany 2010, 2011
Expected in 2009Bachelor's Degree | Business Administration University of Mount Olive, Misenheimer, NCGPA:
Business Administration Management and Organizational Development
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