Highly accomplished, goal oriented, quick learner with an impressive hands-on knowledge base encompassing the entire spectrum of Healthcare. I also write reviews for journals such as the Journal of Health and Human Services. I am an expert in writing in APA style and my knowledge of the English language and grammar are beyond the standard writer. I take pride in my work and assure you that all written material is unique and free of grammatical errors. I have posted my career history below. I look forward to working with you.
CORE TECHNOLOGY COMPETENCIES
Operating Systems: Windows 2000/XP/2007
Databases: SQL • Microsoft Access • SPSS
Software: IDX • Word • Excel • Outlook • PowerPoint • FrontPage • Publisher • Adobe
LONG ISLAND UNIVERSITY-SCHOOL OF BUSINESS Brooklyn, NY
MHA, Health Policy & Management, May 2009
LONG ISLAND UNIVERSITY-LIBERAL ARTS & SCIENCES Brooklyn, NY
BA, Psychology, May 2005
CONFIDENTIAL MANAGED CARE COMPANY, New York, NY 06/2008-Present
Acute & Ancillary Facility Reimbursement Analyst
Charged with containing costs by audits of acute and ancillary facility rates in order to ensure adherence to company policies and contractual agreements. Responsible for presenting audit results on system issues, incorrect claim re-pricing, or contractual conflicts to senior management. Recommends, develops, and implements methods to improve internal effectiveness of the audit process.
· Analysis of reimbursement methodology including review of DRGs, ICD-9s, CPT, HCPCS and Revenue Codes
· Creation/modification of facility rate sheets in NetworX using appropriate reimbursement methodology to maximize automated rates
· Contract Management
· Act as liaison between departments to explain the rationale behind reimbursement interpretations
· Application and data testing as required
HORIZON BLUE CROSS BLUE SHIELD, Newark, NJ 12/2007-06/2008
(Contracted by Algomod Technologies NY, NY)
Analyzed and approved claims for appropriate payment according to member's benefits. Assisted with training of analyst for special projects.
· Completed coding (DRGs, CPTs, ICD 9, HCPCS, Revenue codes) information on claims through CRT
· Ensured adherence to HIPAA protocol
MEMORIAL SLOAN-KETTERING CANCER CENTER, New York, NY 09/2005-11/2007
Patient Accounts/Accounts Receivable/Collector
Responsible for the review and follow-up of underpaid accounts for key non-governmental carriers. Provided support to senior management with functions such as account analysis and problem trends where prioritizing and adhering to deadlines were essential.
· Reviewed and maintained weekly reports to ensure carriers reimbursed in a timely manner
· Performed close analysis of Explanation of Benefits and payment methodology to ensure payments received were in conjunction with approved contracts
· Responded promptly to all payers, patients, or employer requests, concerns and discounts as filtered up from the staff or assigned by the Director or Vice President
DR. MARJORIE E. MCDONALD, D.D.S., Brooklyn, NY 02/2001-09/2005
Managed all front office administrative tasks including staff of three and monitored the collection of payment for dental claims.
· Assumed responsibility for resolution and follow-up of complex patient accounts, third party and governmental payers
· Educated patients on benefits and out-of-pocket expenses
· Trained incoming staff in the area of insurance verification and obtaining pre-determinations
Healthcare Financial Management Association, HFMA
National Association of Health Services Executives, NAHSE