Medical Insurance
Resume:
Street 717-***-****
Lancaster PA Home 717-***-****
17602
diatomicdiana@hot
mail.com
Diana L Morgan
Objective To obtain a rewarding professional career as an
analyst in a Healthcare IT.
Experience 06/2008-Present Lancaster General Health Lancaster,
PA
Certified EPIC Resolute Claims System Administrator
Responsible for building and maintaining EPIC PB
system application as it relates specifically to
claims and remittance. Highly experienced and
knowledgeable of 837I/P/D, UB04, 1500 and ADA
transaction types as they relate to HIPAA
requirements and experience with 835 remittance
files. Able to develop and implement test plans and
procedures. Responsible for training and mentoring
new System Administrators and also developing
training material for the purpose of optimization
of front end and billing staff. Participates in
implementation of EMR and working knowledge of
EPICcare EMR system. Responsible for PQRI
implementation as it relates to building claim
edits to ensure proper reporting of PQRI measures
to Medicare. Experience and knowledge as it
pertains to EPIC EMR implementation training and
GO-LIVE support. Recent experience and knowledge of
EPIC 48 hour install build and procedures as it
relates to Claims and Remittance. Knowledgeable
with EDI enrollments as it relates specially to
Clearing House requirements and payor set up for
claims, remittance and eligibility processing.
Skilled in ePremis claims scrubbing software with
the responsibility of training, maintaining and
supporting the functionality of the application,
familiar with set up claim job/batch, download
files and remittance processing and interfaces,
experience using data courier tool for moving
specific build to different environments in the
EPIC application.
07/2007-06/2008 Siemens Medical Solutions Malvern,
PA
Payer Rules Analyst
Participate in research and development of artifact
design, collaborating on and participation in
review sessions to clearly translate customer
requirements into Analysis documents including
acceptance tests for business rules. Other
responsibilities include analysis of payer
documents, companion guides, and billing manuals to
acquire rules and requirements for software
development. Experienced and knowledge of 837I/P/D,
UB04, 1500 and ADA transaction types as they relate
to HIPAA requirements. Able to develop and
implement test plans and procedures.
04/2005-07/2007 Lancaster General Hospital
Lancaster, PA
Supervisor, Account Resolution
Responsible for the daily operations of an A/R area
for hospital claims collections and recovery and
was an active team member of a management team.
Managed and mentored nine staff level account
representatives. Experience and knowledge of
healthcare finance as it relates to insurance
reimbursement, cost analysis, denial management and
recovery of aged inventory. Responsible for
tracking, trending and reporting deficiencies in
billing practices. Extensive knowledge and skills
in the areas such as but not limited to of coding
and billing practices as they relate to hospital
and professional claims.
02/2003-04/2005 Lancaster General Hospital
Lancaster, PA
Account Resolution Specialist, Account Resolution
Responsible for an inventory of patient hospital
accounts to collect on insurance payments. Reviewed
denials, take backs, and insurance contractual
adjustments for accuracy. Experience and knowledge
of healthcare finance as it relates to insurance
reimbursement, cost analysis, denial management and
recovery of aged inventory. Responsible for
tracking, trending and reporting deficiencies in
billing practices. Extensive knowledge and skills
in the areas such as but not limited to correct
coding and billing practices as they relate to
hospital and professional claims.
Education 01/2006 Rasmussen College Minnesota
Health Information Technology
RHIT Program with an emphasis on medical coding and
medical records.
07/2009 Rasmussen College Minnesota
Computer Technology Degree Program
CT degree program with an emphasis on computer
technology.
Competencies Analytical process oriented individual. Certified
EPIC Resolute PB Claims System Administrator with
experience in Hyperspace and Text (Dark Side
application). Experience and train the trainer
ability with regard to Relay Health ePremis claims
software solution products Siemens Sorian Certified
Experience with most Microsoft Office Applications,
including Excel, Outlook, Word and Access. Other
computer application experience includes, Lawson,
Clearcase, IBM Clear Quest, various Databases, RAS
and Medical Records and Billing applications.
Contact this candidate