Senior Analyst, Systems and Reporting (Revenue Cycle Management) HB/PB - United Digestive
(2024-12)
As a Senior Revenue Cycle Management Analyst, I have a crucial leadership role in optimizing the operations of the business by expediting clean claim submissions and ensuring timely payer reimbursements. My responsibilities also include extensive data analysis and collaboration across multiple facilities to identify operational issues and provide actionable insights to enhance revenue cycle performance.
- Identified appropriate charge capture and charge reconciliation. Research appealed and/or denied rejected claims
- Own Insurance Database, Provider Enrollment, and Clearinghouse Database
- Lead the resource and reference for the systems related to charges, charge compliance/capture, and reimbursement/collection impacts
- Strong detailed knowledge of core Revenue Cycle systems and software solutions
- Plays a crucial role in optimizing the operations of the business by expediting clean claim submissions and ensuring timely payer reimbursement
- Took Ownership of tracking daily Key Performance Indicators (KPIs) such as Accounts Receivable (AR) days, claim submission, denial rates, clean claim and cash flow while monitoring revenue cycle process
- Responsible for the reviewing of patient accounts, charge capture accuracy, and coding compliance to identify revenue leakage
- Investigates root causes of claim denials, rejection delays, and underpayments, and initiating corrective actions
- Lead the navigation of extensive data analysis and collaboration across multiple facilities to identify operational issues and provide actionable insights to enhance revenue cycle performance
- Responsible for routine financial reports and dashboards using tools such as Power BI for leadership
- Runs, reviews, interprets, analyzes, and validates Revenue Cycle medical billing reports
- Oversee the integrity of data provided to all areas of the revenue cycle, including KPI's and other areas of the organization is necessary for good decision making
- Partners with Revenue Cycle leaders and other stakeholders across the organization to identify and address operational issues related to Revenue Cycle performance
- Excellent verbal and written skills for presenting findings to management
- Lead internal initiatives and projects related to Revenue Cycle data analytics, and reporting
- Foster strong relationships, and collaboration with providers, department leadership, and team members
- Conducts revenue cycle analysis and provides trends as needed by Revenue Cycle leadership team to identify improvement opportunities
Analyst, Post Payment Integrity Validation - Northside Hospital
(2023-05 - 2024-11)
As the Medical Post Payment Review Billing Analyst, I was responsible for ensuring accuracy, compliance, reconciling payer contracts, and efficiency of the billing process after payments have been received. Conducted thorough post-payment reviews of medical billing transactions to ensure accuracy in coding, documentation, and reimbursement. Assured that all billing claims comply with healthcare regulations, coding standards (such as ICD-10, CPT, HCPCS), and payer-specific guidelines.
Found and resolved billing errors, discrepancies, or inconsistencies that may result in claim denials or underpayments. Established root causes of denied claims, identified corrective actions, and minimized future denials.
- Managed entire revenue cycles, from charge capture to reimbursement. Identified and implemented revenue optimization and billing cycle time reduction strategies
- Expertise in medical coding (ICD-10, CPT, HCPCS) and compliance regulations. Ensured that billing errors are avoided and regulatory issues are avoided by ensuring accurate and compliant coding practices
- Established a track record of analyzing and resolving claim denials quickly. Implementation of strategies to minimize claim denials and maximize reimbursement rates
- Interpreted financial data, identified trends, and made data-driven decisions based on that data. Analyzing billing data and identifying areas for improvement using data analytics tools
- Achieved accuracy in Medicare and Medicaid account balances through the reconciliation of contractual adjustments and payments
Team Lead, EDI Billing - Go Health Urgent Care
(2020-03 - 2023-05)
As an EDI Billing Analyst Team Lead, I was responsible for managing, optimizing, and implementing EDI billing processes. Collaborating with the IT department to address technical issues and optimize the system. Aligning EDI processes with organizational goals in partnership with business units. Monitoring the performance of the EDI billing system and team. Implementing key performance indicators (KPIs) to assess and improve overall efficiency.
- Led a team of EDI billing specialists. Assisted team members with guidance, support, and mentoring
- Provided oversight for the implementation and optimization of EDI processes within the billing system. Facilitated the exchange of electronic data between the organization and its external stakeholders
- Filled in denied/rejected claims appropriately and correctly as they are received from providers, coders, and billing departments. Reviewed remittance codes from EOB/ARs to ensure correct contracted reimbursement rates are used
- Troubleshooted complex EDI issues and discrepancies. Worked collaboratively with team members and relevant stakeholders to resolve problems
- Contributed to the success of colleagues by acting as a resource. Specialist in Prior Authorization processes with insurance companies and practitioner offices
- Responsible for the daily submission of insurance claims for assigned clients. Corrected system edits and payer rejections. Worked with supervisors and clients lead to identifying and resolving edit and rejection trends. Utilized knowledge of the revenue cycle and patient accounts to ensure claims are submitted in a timely manner
- Batched and submitted claims for all formats for assigned clients daily
- Ran and corrected system edits and released edited claims for submission
- Monitored EDI claims transmission reports. Resolved or communicated transmission errors to EDI supervisor
- Researched and worked EDI rejections after initial claims submission. Corrected and resubmitted claims when rejections are resolved
- Sent unresolved edits and rejections to the client lead for resolution requiring client involvement
- Completed all activities in a timely manner
- Identified edit and rejection trends and communicated issues to the EDI Supervisor
- Submitted written summary of edit and rejection trends to Supervisor monthly
- Maintained an appropriate and accurate documentation system
- Demonstrated the working knowledge of all appropriate billing forms, ub04, 1500 or state specified forms, utilizing the electronic billing systems
- Responsible for submitting Claim Reconsiderations, first level, second level appeals and claims forwarded to the Insurance Commissioner
- Identified additional billing edits required to submit clean claims and compliant billing to all payers
- Responsible for documenting billing activity including but not limited to the following: bill dates, notes, and electronic note posting
- Audited each bill for charges, duplications and overlapping accounts before billing, making any necessary adjustments and documenting
Analyst, Physician Denials (Revenue Cycle Management) - Atlanta Women's Health care Specialists
(2017-01 - 2020-03)
As a Physician Denials Management Specialist, I reviewed and resolved denied patient insurance claims in an OB-GYN Physician practice setting. My duties included forming written appeals with documentation and an argument and following up with the insurance company about possible reimbursement. My responsibilities also included assisting insurance companies with gathering additional paperwork they may need to process a denial appeal from a patient, and keeping a detailed record of all communications with patients and insurance companies during the appeals process.
- Responsible for thoroughly investigating/troubleshooting high dollar claim past the 60–90-day mark
- Accurately entered procedures codes, diagnosis codes, and patient information into the physician billing system
- Responsible for confirmed patient information
