Analyst

Team Health - Akron Billing Center

April 2013 – Present (1 year 2 months)

• Responsible for the coordination of the Eligibility Department for monitoring workflow, production, training, auditing and reporting performance, Assist with recruiting new applicants within the eligibility department

• Full registration of patient demographics

• Familiar with insurance web sites

• Work from various source documents

• Properly code patient files according to established policies and procedures

• Identify FSC according to insurance cards and/or patient’s demographics

1. Identify appropriate FSC, insurance company and/or Medical Group.

2. Monthly QA of all Eligibility staff and maintains accuracy report

3. Assists Eligibility Analyst with questions and/or problems

4. Work with other production departments to coordinate workflow

5. Enter patient demographics according to established procedures

6. Maintain department production, quality, and training

7. Evaluate and coordinate daily workflow and distribution

8. Use resources, such as web sites, HDX, Seimans to resolve eligibility issues

9. Report performance and workload of department to Director

1. Review daily claim (DMS and TES) edit reports, identify and make corrections as necessary.

2. Perform any and all of the duties assigned by Director.

AR Analyst

July 2012 – Present (1 year 11 months)

Team Health Akron Billing Center

Reviewed ATBs monthly.

Recognized potential problems including Provider Enrollment issues, CMD-1500 format problems, claims transmission problems, internal processing problems, erroneous demographic and insurance information, etc.

thorough and knowledge of Team Health billing directives and processed all claims according to these directives.

The goal was to insure that the claims were paid correctly in a timely manner.

Medicare invoices were to be worked either via phone call or tracer claims submissions. This included calling for status, requested medical records, and researched payments, adjusted claims for non-payable procedures and time limits, FSC change (deductible).

Processed Medicaid invoices, either via phone call or tracer claims submission. Processing included making phone calls for claim status, preparing extension forms or crossover forms, filed appeals.

Processed non-Medicare and Medicaid carrier claims according to the Team Health and A/R Department policies and procedures when the claims were processed.

Processed Medicaid payment denials, including posting rejections, conducted appeals, requested medical records. The payment denials were worked within seven working days after receipt in the department.

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