Reimbursement Analyst Resume Samples
Reimbursement Analysts work in medical facilities and determine patient reimbursement amounts. Essential job responsibilities of a Reimbursement Analyst are processing reimbursement requests, assisting patients, answering to inquiries, maintaining their knowledge of payer policies, analyzing data and documents, and maintaining records. A successful resume sample in the field should mention skills such as knowledge of reimbursement policies, customer service, strong numeracy abilities, effective communication, conflict resolution, recordkeeping, and computer competences. Business training is seen on most eligible resumes, but candidates holding just a high school diploma may also be accepted.Looking for job listings? Check out our Reimbursement Analyst Jobs page.
Senior Reimbursement Analyst
- Audited incoming payments for over 200 emergency room and hospitalist clients across the country
- Brought in $44,000 for an IL client by working with the state insurance agency and payer
- Managed several high profile projects including a re-coding project with United Healthcare valued at approximately $1 million in charges
- Sought out and fostered relationships with various payers and some state agencies, as well as researched low payments and resolved contract payment disputes
- Resolved incorrectly discounted claims with third-party processing companies such as Multiplan and Stratose, receiving additional payments or settlements for well over $70,000
- Built and maintained relationships with inter departments to resolve payment and contract issues
- Initiates appeals to third party carriers for erroneous reimbursement and analyzes contracts to find reimbursement discrepancies
- Analyze inpatient and outpatient accounts for claim denial trends and utilizes lean methods to create processes to increase efficiency and decrease waste
- Implemented new billing process that reduced 20% of aging AR
- Specializes in reimbursement for Medicaid and Medicaid risk plans. Surpassed industry standard working more than 50 accounts a day
Reimbursement Analyst/coder-philadelphia Liaison
- Provided information on claims correspondence and assisted in the daily support and reimbursement of claims.
- Worked and negotiated contracts for various acute and rehabilitation facilities to determine fees for products: Direct Access, Managed Care and PPO.
- Supervised 11 staff members in the Administrative Office encompassing Accounts Payable/Receivables, and Collections.
- Process facility and professional claims on the following forms (UB04, HCFA 1500, and UB92).
- Utilizing Affinity Billing System, Medicare, Medicaid, and Medicare HMO claims and submit crossover claims as necessary.
- Reviewed claims for (ICD-9, 10, CPT, HCPCS), units, and procedure codes also utilizing NPS Benefit coding.
Analyze and process account receivable to ensure continuous cash flow and develop strategies while utilizing excel and payer projects.
- Monitor National business accounts in excess of $60 million dollars yearly.
- Communicate with management with any changes involving compliance, regulation and reimbursement issues
- Develop effective strategies to enhance cash flow.
- Develop and maintain relationships with other departments to streamline operation.
- Develop detailed spreadsheets to identify trends and develop forecasts. Consolidate and analyze monthly results.
- Research and document various issues.
- Mentor and coach junior staff
- Streamline cash flow $300,000 monthly
- Streamline work flow which resulted in 20% decrease in errors yearly.
- Serve as a liaison between departments (Psychiatry, CIDD, TEACCH and Emergency Medicine) and Revenue Cycle Analytics.
- Work closely with clinic managers, staff and physicians to review denials, physician's notes and aged claims to improve reimbursement by insurance payors.
- Facilitate weekly meeting to present Key Metrics to leadership within the healthcare.
- Analyze denials from insurance payors to identify trends and determine root cause of denial.
- Utilize Business Objects to create reports to fulfill internal and externals ad-hoc requests, as well as maintaining ongoing scheduled reports.
- Draft system edits and logic for Epic to ensure claims are routed to the work queues.
Reviews patient data to prepare current year bad debt listings while making sure the facilities recognize their full reimbursement potential.
- Exchanges data with clients and third-party data sources, such as vendors, Medicare, Medicaid, etc.
- Troubleshoots situations where data does not meet established thresholds and standards.
- Maintains strong knowledge of all HPS products and services.
- Reviews prior year patient data to identify missed reimbursement opportunities for bad debts and disproportionate share.
- Investigate underpayments on pharmacy prescription AAC and NADAC Medicaid CMS claims
- Analyze acquisition cost data and market pricing to arrange rate increase proposals independently
- Quality inspector of managed care claims to verify accuracy after data entry before final review
- Develop employee training guides and tracking logs for new review processes in Excel and Access
- Create monthly marketing reports and cross-check rate updates and analysis data via SQL
- Creating and Uploading Fee Schedules and Contracts to our Billing Software (Epic)
- Calculating reimbursements received from the Payor
- Maintaining spreadsheets with Payor Issues
- Working with Payors on payment issues to get them resolved in a timely manner
- Building and maintaining Payor and Plan contracts within Epic
Reimbursement Analyst (contract)
- Collected and reviewed all patient insurance benefit information
- Maintained frequent phone contact with provider representatives, third party
- Customer service representative, pharmacy staff, and case managers
- Re-verify patients coverage and benefits
- Provided stellar customer service to internal and external customers
- Manage Accounts Receivable to ensure timely and maximum reimbursement
- Appropriately appeal insurance claims in a timely manner
- Research and write up refunds
- Review dictation and operative reports adding or correcting diagnosis codes when needed to get claims processed and paid, appealing unpaid charges when necessary
- Correct adjustments and move money between accounts to correct billing errors when needed
- Participate in team meetings to manage and plan the best patient care
- Provide the customer service possible by developing and maintaining an effective and efficient relationships with the patient
- Routinely prepare reports and present data to organizational level management
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Wellmont Health System – Kingsport, TN
- Responsible for accounting duties for hospitals including financial statement preparation.
- Prepare month end contractual adjustments and reports.
- Assisted external auditors by obtaining information for year-end audit.
- Maintained and reconciled fixed asset database.
- Audit individual patient accounts for accuracy of charges and reimbursement.
- Research insurance contracts and payment variance issues and reconcile.
- Prepared year end reports for governmental agency reimbursement including DSH and Medicare cost reports.
- Assist internal auditor in dividing charges when an organ donation occurs.
- Identified and accounted for IME payments on Medicare claims.
- Analyze chargemaster charges for appropriate coding and pricing.
Heritage Management Services – Elizabethton, TN
- Responsible for monthly reconciliation of general ledger, inventory, and bank accounts for fourteen branch locations.
- Internally audited branch locations for compliance with accounting policies and regulatory statutes.
- Processed payments and aid in collections of accounts receivable and bad debt.
- Processed accounts payable.
- Prepared monthly sales tax returns.
- Prepared annual budget and other analytical reports as needed.
Bishop, Bullard, and Company CPA's – Kingsport, TN
- Compiled and prepared financial statements for clients.
- Performed external audits.
- Prepared corporate and individual income tax returns.
- Prepared property tax and other regulatory reports for clients.
- Reviewed and verified accuracy of bookkeeping staff reports.
Black Diamond Savings Bank – Norton, VA
- Prepared financial statements and internal reports for use of management.
- Reconciled bank statements.
- Reconciled general ledger accounts.
- Prepared and filed governmental regulatory and compliance reports.
- Prepared and filed sales tax returns.
- Performed customer service including research of customer accounts.
The Country Store – Appalachia, VA
- Owned and operated antique and craft consignment store.
- Performed all management and accounting functions of business including bookkeeping, inventory procurement, tax return preparation, marketing, and sales.
University of Virginia at Wise -
Mountain Empire Community College -
American Association of Professional Coders -
|Proficient in a variety of software programs including:|
Microsoft Office including: Excel, Word, Access, Power Point, and Info Path.
Healthcare specific programs including: STAR, Horizon Patient Folder, Pathways Contract Management, Pathways Financial Management, and MedAssets Knowledge Source.
|Currently enrolled in an AAPC course to become a Certified Professional Coder. Proficient in using UB Editor and Medicare Addendum B and other fee schedules as well as reading and interpreting insurance contracts. |
CPA eligible by having met education criteria.
Possess excellent analytical skills.