Reimbursement Analyst resume examples

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Professional Summary
Qualified Candidate that can provide the customer with business analysis expertise and project support. Willing to be responsible for gathering, analyzing and documenting business and functional requirements.
Work History
Current Reimbursement Analyst | Occam Health Services | Sterling, VA
  • Continually maintained and improved the company's reputation and positive image in the markets served.
  • Strategically planned methods to achieve operational goals and targets.
  • Encouraged creative thinking, problem solving, and empowerment as part of the facility management group to improve morale and teamwork.
  • Investigated, provided and submitted information to Quality Department about special incidents, events and complaints.
May 2017-January 2018 VIP Cocktail Waitress | Kabana Rooftop | Richmond, VA

  • Built close relationships with my client base through enthusiastic communication, excellent service, phone calls, emails and other communication channels.
  • Received frequent customer compliments and positive Yelp reviews for going above and beyond normal duties.
  • Resolved all customer complaints, requests, and inquiries from assigned clientele base; handled difficult clients and situations in a calm and professional manner.
March 2015-August 2016 Pharmacy Supervisor and Care Coordinator | Akina Pharmacy | South Riding, VA
  • Experience with administrative, clerical, record-keeping and computing skills with specific software. 
  • Improved overall satisfaction for our patients within a year.
  • Provided support in developing customized quotes with our vendors for chemicals and shipping arrangements.
  • Worked with upper management to arrange meetings to obtain quotes from partners and outside vendors to lower cost of production.
  • Developed training materials and conduct end-user training sessions
May 2012-March 2015 Lead Pharmacy Technician | CVS | South Riding, VA
  • Resolved non-routine issues like third-party billing, computer system and customer service issues.
  • Maintained proper drug storage procedures, registries, and records for controlled drugs.
  • Counted, measured, and compounded medications following standard procedures.
  • Communicated with doctors to verify medication dosages, refill authorizations and patient information.
  • Supervised 4 pharmacy technicians and coordinated day-to-day assignments.
  • Completed new and updated patient profiles, including lists of patient medications.
June 2010-August 2011 Teacher | Discovery Station Learning Center | South Riding, VA

  • Worked on a team to lead, encourage and minister to children from ages 3 months up to 12 years of age.
  • Met regularly with parents and guardians to discuss children's progress.
  • Planned and implemented creative lessons in accordance with district, county, state and federal guidelines.
  • Completed and filed all necessary paperwork for classroom activities, including meal count sheets and attendance logs.
2017 Bachelor of Science: Interdisciplinary Studies Virginia Commonwealth University, Richmond, VA
  • Concentration in Professional Science
  • Minor in Psychology
  • Coursework in Speech, Communication, Sociology, and Professional Prospecting Skills.
  • Microsoft Word
  • Microsoft PowerPoint
  • Microsoft Excel
  • Microsoft Publisher
  • Customer-focused
  • Effective problem solver
  • Exceptional telephone etiquette
  • Exceptional interpersonal communication
  • Life, Health and Annuities Licensed in Virginia
  • Pharmacy Technician (CPhT)
  • PCCA Comprehending Compounding Course (C3)
Mu Alpha Theta - Mathematics Honor Society 
This resume is created in 7 minutes.
  • Problem solving
  • Customer service
  • Maintains confidentiality
  • Dedicated team player
  • Office support (phones, faxing, filing)
  • Familiar with commercial and private insurance carriers
  • Account auditing
  • Close attention to detail
  • Insurance and collections procedures
Work History
Account Receivable Representative, 06/2017 to 09/2017
MedSynergies, Inc. Irving , TX
  • Contacted government(Medicare, Medicaid) commercial & managed care insurances via web/ phone to verify claim status
  • Appealed denials with appropriate documentations
  • Researched contracts to verify correct payments
  • Verified and updated patient information
  • Worked correspondence
  • Consulted with hospital/provider office for procedure accuracy
  • Submit Medical Records/Prior Authorization
  • Updated Provider credentialing
  • Verifyinsurancebenefits
  • Verify authorization for services
  • Request retro authorization if applicable
Senior Reimbursement Analyst, 01/2017 to 05/2017
Evolution Health Dallas , TX
  • Maintained strict patient and physician confidentiality.
  • Confidently and adeptly handled claim denials and/or appeals.
  • Submitted electronic/paper claims documentation for timely filing.
  • Reviewed and resolved claim issues captured in TES/CLAIMS edits and the clearing house.
  • Confirmed accurate completion of forms/reports for the admission, transfer and/or discharge of each resident.
  • Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
  • Verified patients\' eligibility and claims status with insurance agencies.
Commercial Insurance Biller, 12/2015 to 03/2016
CHRISTUS Health Irving , TX
  • Completes all third party electronic and manual billing timely and accurately in accordance with appropriate rules and regulations.
  • Completes all payer specific edits identified through the billing system.
  • Resolves issues associated with incomplete claims including follow up of non-transmitted claims.
  • Submit adjustment claims to Commercial and Third Party through use ofChristusHealthsoftware programs.
  • Requesting appropriate documents when billing manual claims including ER reports, itemized bills, implant invoices and other medical records.
  • Rebilling claims electronically to commercial insurances and third party payers daily.
  • Works all daily reports as assigned.
  • Records daily productivity of claims billed and assures proper documentation in the notes of the patient accounting systems.
  • Completes all monthly required in-services and educational training as required.
  • Other duties as assigned
Reimbursement Specialist, 09/2015 to 11/2015
US Renal Care, Inc. Plano , TX
  • Follow up on unpaid and underpaid account balances for OON insurances carriers.
  • Complete re-bill request as necessary to facilitate timely and proper claims payment.
  • Performs claims appeals as required
  • Performs retro-authorization appeals as required
  • Review and researched insurance correspondence and makes necessary corrections to ensure claims payment.
  • Provides insurance carries with requested information to facilities payment.
  • Prepares forms and necessary information to transfer payment and/or missing payment to be posted.
  • Work on special projects as need it.
Billing Coordinator, 04/2008 to 07/2015
University of Texas Southwestern Medical Center Dallas , TX
  • Reviews and processes Insurance claims through Epic billingsystem, including Medicaid, Medicare, Commercial Insurance, Veteran Affairs, Worker\\'s Compensation and third party payers.
  • Identify problems and inconsistencies.
  • Function as a resource person for departmental personnel to answer questions and assist with problem resolution.
  • Resolve electronic claims rejections and EOB\\'s denial in a timely manner
  • Review and resolved correspondence from all organizations
  • Upon receipt of insurance payment, bill secondary insurance and/or patient
  • Contact patients to obtain insurance information needed to process claims such as COB information, accident details, preexisting questionnaire, etc
  • Prepare adjustments such as refunds, contractual differences and write-offs for approval and processing
Medical Eligibility Specialist, 02/2018 to Current
Health and Human Services Commission Austin , TX
High School Diploma: 1987
DeVry University - Irving , TX
  • Medical Terminology
  • International Classification of Disease Coding 9/10
  • Current Procedure Terminology
  • Fundamentals of Human Anatomy and Physiology Pathopharmacology Introduction to Health Services and Information Systems
    This resume is created in 7 minutes.
    Driven medical biller and collector with over 10 years experience in facility and professional insurance billing, claims processing, and collections. Excellent multi-tasker, analytical thinker, and demonstrated team player with a positive attitude.
    Skill Highlights

    • Extensive experience in debt collections
    • HIPAA Compliance 
    • Provide exceptional contributions to customer service for all patients and insurance payors


    • Meticulous attention to detail
    • Impressive problem solver
    • Strong interpersonal skills
    • Self-directed
    • Excellent time management skills
    Work Experience
    01/2017 to 08/2017
    Child Support Specialist Shasta County Child Support Services Redding, CA Performed a wide variety of child support duties consisting of maintaining a caseload, locating and interviewing custodial and non-custodial parents and others to elicit factual information for the purpose of establishing child support obligations and enforcing child support laws; arranges for support payments; prepares cases for court hearings as necessary; and performs related work as required.
    06/2015 to 07/2017
    Camp Office Manager Kids Unlimited Institute of the Arts Redding, CA
    Served on Kids Unlimited Board of Directors as Vice-President.
    Worked during 6-week summer performance program as Camp Office Manager addressing all camp related questions and issues from parents, students and staff. Dealt with a wide range of personalities while maintaining a professional disposition. Maintained accurate student records, answered camp phone, collected cash/credit/check payments.  Administered first-aid to ill and injured students. Handled student discipline and recognition. Supervised student breaks and lunches. Schedule back-stage staffing, and substitute coverage for absent staff.
    Daily use of computer, fax, copy machine, camp phone.
    04/2013 to 04/2016
    Collector Shasta Regional Medical Center Redding, CA
    Work patient accounts assigned via work list to a final disposition.
    Correspond via telephone and written letter with patient, insurance company, and various third parties to confirm claims process efficiently. Applied payments, adjustments, and denials. Keep up to date and thorough account collection notes. Compute expected reimbursement by accurately calculating contractual adjustments, and patient benefits.
    06/2010 to 12/2012
    Lead Biller Collector / Back-Up Front Office Receptionist McCallum Family Practice Redding, CA
    Perform full-cycle medical billing and collections in fast paced Family Practice. Provide administrative support for 3 medical providers as back up Front Office Receptionist.​
    Accurately completed patient registration quickly and cordially. Verify patient personal and insurance information and collect all co-pays and deductibles. Answer multi-line phone and either transfer call to appropriate staff member or record clear and detailed written message. 
    08/2006 to 04/2008
    Reimbursement Analyst Shasta Regional Medical Center Redding, CA Maintained all master insurance contracts between insurance payer and facility. Regularly examined and updated contract profiles via facilities online adjudication system. Completed daily financial impact spreadsheets and various "special projects" for management, hospital administration and corporate office. Assist other department employees with daily tasks when needed.