Insurance Computer Science

**** ******* ***** **. • Rowlett, TX ***** • 214-***-****

E-Mail: ********@*****.***

Hiland Nguyen Penticuff

OBJECTIVE

Achievement oriented claims analyst seeking to leverage background problem solving, operational planning,

presentation, and quality management as an analyst in the information technology field. Extremely enthusiastic

for career change goal and eager to contribute to the company’s Business and System Applications department.

PROFESSIONAL PROFILE

Highly motivated professional with significant experience; computer literate in multiple programming

languages and software applications; enthusiastic about building a solid programming foundation, enhancing

current technical expertise, and applying transferable skill sets.

Creative troubleshooter/problem-solver eager to meet challenges and quickly assimilate newest and latest

technologies, skills, concepts, and ideas.

Highly analytical team player with aptitude for quickly scrutinizing environments to identify and prioritize

needs/risks and develop solutions.

Self-starter able to follow through with projects from inception to completion.

Proven relationship-builder with exceptional interpersonal, communication, and presentation skills.

EDUCATION

Grantham University – Kansas City, MO, Jan. 2009 - current

Current pursuing Master of Science-Information Technology

Grantham University – Kansas City, MO, Dec. 2006 – Sept. 2008

Bachelor of Science, Magna Cum Laude, Computer Science

Associate of Science, Computer Science

University of Texas at Dallas - Richardson, TX, 2001 – 2005

Completed basic course requirements for B.S. degree in Computer Science & Biology

Richland Community College – Dallas, TX, 1997-2001

Completed basic course requirements for B.S. degree in Computer Science

Eastfield Community College – Dallas, TX, 1997-2001

Complete basic course requirements for B.S. degree in Computer Science

RELATED COURSEWORK

Computer Information Systems, Microcomputer Applications, Database Applications, Management Information

Systems, Principles of Business Management, Technical Report Writing, Operating Systems, Systems Analysis &

Design, Database Design, Systems Architecture, E-Business, Management of Information Systems,

Telecommunications, Information Systems Strategic Planning, Project Management, System Design

SYSTEMS EXPERIENCE AND PROFICIENCY

Applications Hardware Programming

Languages

C++

Windows OS Siemens OAS- Install Setup Local

Java

Gold Motherboards, Networks

Microsoft Office

Hard Drives, HTML

Suite – Word, Xactimed Configure Local

RAM, Network

Excel, Routers C

Onbase Imaging

Adapters

PowerPoint, JavaScript

Contract

Access, Outlook Install OS and

Management XML

other software

MS Visual Studio Centricity/

2005 Install Printers

Millbrook

TextPad EncounterPro

PROFESSIONAL EXPERIENCE

Claims Resolution Analyst – UT Southwestern Medical Center of Dallas, Dallas, TX, July 2006 – Present

Process all assigned payer’s claims for reimbursement.

Apply and maintain all records pertaining to contract pricing and medical fee schedules.

Review accounts to ensure each "Usual and Customary" (UCR), non-allowable, and courtesy discount entry is

computed correctly and appropriate adjustments are made.

Work with other departments to resolve issues such as contract management, coding, electronic claim

submission, and pre-certification denials.

Utilize aged accounts receivable reports to maximize collections.

Research and appeal when necessary all insurance denials.

Correct patient insurance and demographic information for future patient registrations.

Meet or exceed successful claims closure goals as set forth by collections director/supervisor.

Patient Accounts Representative – Texas Health Resources, Dallas, TX, May 2005 – June 2006

Analyzed, identified, and solved insurance reimbursement problems.

Reviewed past due accounts and recommend whether account should be written off, referred to collection

agency, or set up on payment schedule with patient for minimum payments each month.

Utilized review reports to identify reimbursement problems with insurance companies.

Composed letters to insurance companies to resolve recurring reimbursement problems.

Telephoned insurance companies to resolve contract issue regarding rates of payment.

Trained new staff on proper collection procedures.

Account Specialist – Prima Health Clinic, Garland, TX, April 1998 – May 2005

Prepared and supervised proper insurance claims filing to Medicare, Medicaid, major and minor health

insurances.

Trained and managed employees on proper billing, collection, payment, appeals protocols.

Reconciled accounts payable and receivable for patients, insurance payers, and third party labs.

Reported bad debt accounts to Experian Credit Bureau.

Trained new staff on administrative duties such as data entry, insurance verification, and answering multi-line

phone system.

Contact this candidate