Healthcare, HIPPA EDI, Project Msnagrment

** ******** ******, ********* ** ***** * 617-***-**** * *********@*****.***

Valerie Tower

Objective

Highly motivated and driven professional with over 20+ years of Healthcare experience. Strong hospital billing background with a thorough knowledge of the Revenue Cycle process. In depth Knowledge of HIPAA EDI 5010 X12 Transactions such as 837 (Institutional, Professional & Dental), 835, 997, 277 & 271.

Recognized for well-honed analytical skills, ability to plan and execute initiatives effectively with attention to detail and strong relationship management capabilities. Seeking to work in an environment that will challenge me further in order to apply vast analytical and Project management work experience to a growing industry and to motivate team members and increase productivity

Experience

Partners Healthcare

Boston, MA.

September 2002–June 2017

Epic Business Analyst [2016 – 2017]

Hospital Billing Business support analyst triaging incoming system conflicts using an incident management system (Service Now) used to track system flaws and solutions and bring them to resolution or provide a handoff to the appropriate team.

Document and report system issues through established processes and communicate and follow up with end users on status where appropriate

Work with Business owners to facilitate requirements gathering sessions to define system enhancements or defect resolution.

Provide technical input in the design using knowledge of the Partners Epic Revenue Cycle System.

Increased productivity as an Epic Hospital Billing revenue cycle subject matter expert to support enterprise wide initiatives. Work with Users to understand and document workflows and concerns in a variety of areas

Intermittently act as on-call support for end users with urgent revenue and clinical system issues directly impacting patient care

Senior Revenue System Analyst/Project Coordinator [2013 – 2016]

Coordinated with project teams on complex projects to plan, design, track and implement new requirements, processes and strategies that are incorporated into the Revenue Cycle Operation’s footprint ensuring that the projects are consistent with corporate standards, efficiencies and resource management.

Proven track record in delivering complex projects using varied development approaches to address internal or external development. Projects managed include:

oICD-10

o4010 / 5010 Transition

oHIPAA 837 (Institutional, Professional & Dental), 835 and 270/271

oNational Provider Identifier (NPI)

oAPR DRG

Facilitated functional and integrated testing including designing test plans, develop test cases, executing user testing approach for a successful end result that would span across multiple Partners entities

Managed the dual reporting requirements of a project management environment which includes flexibility, relationship building, professional accountability and the ability to communicate at all levels required to support the various reporting relationships in a professional manner.

Adhere to project management tools and methodologies using established PM framework

Revenue Systems Team Lead [2009 – 2013]

Assumed the responsibility of a team lead by creating more production in the department to meet and exceed all timelines, plans and goals

Created and maintained quality client relationships based on integrity and trust, collaboration and mutual respect (The confidential nature of discussions required to effectively support challenged projects must be respected.)

Led team meetings to discuss, troubleshoot and coordinate system changes requiring collaboration from various members of the team including a review of conflicts and projects the team is working on

Provided guidance, communication and education on current Revenue Systems projects to the team which included mentoring, motivating and guiding employees ensuring all were trained in product knowledge and capable of performing assigned duties while continuing to adhere to rigorous standards for customer service, policies and guidelines.

Worked with Senior Management to identify areas of improvement across a multitude of billing systems demonstrating knowledge of company's mission, purpose, goals, and the ability to help employees successfully achieve them

Senior Revenue Systems Analyst [2002 – 2009]

Served as a primary contact with business areas to troubleshoot end-user issues and requests to provide appropriate system solutions in a timely manner to ensure a consistent and efficient workflow

Successful in rolling out a Provider Hierarchy mapping tool to increase claims submission and minimize Third Party denials for lack of sufficient Provider information

Processed and reconciled files for Electronic Data Interchange and Automated Clearing Houses including HIPAA EDI 5010 X12 Transactions such as 837 (Institutional, Professional & Dental), 835, 997, 277 & 271. This included leading a team of business owners in testing of the transition of HIPAA Remittance EDI files from a 4010 format to the new 5010 version (837, 835)

Worked closely with a variety of multi-disciplinary teams to facilitate the development of a Denial Management process utilizing mappings of all 835 Adjustment Reason Codes to allow for minimal denials and increased reimbursement from the Third Party Payers

Work with Business owners to gather requirements for enhancements or system fixes. Provide technical input in the design using knowledge of the Legacy billing systems to improve both the functionality of the software and end user satisfaction

Beth Israel Deaconess Medical Center Boston, MA. February 1986–September 2002

Senior Reimbursement Analyst

Participated in many aspects of government third party reimbursement

Assisted in the preparation and analysis of all areas / schedules used for cost report filings to government agencies (Medicare and Medicaid)

Coordinated the Medicare Audit with Medicare playing an integral role in the audit of Capital Expenditures. Disputed and was successful in a $13M write-off reversal resulting in a significant savings for the hospital

Established a working knowledge of regulations and calculations impacting the cost reports including those related to Capital Budget expenditures and Disproportionate Share Hospital (DSH) Payments

Created and maintained bad debt database for submission of closed claims for reimbursement

Gathered, analyzed and organized data related to overhead statistics, direct costs, data collection and analysis, regulation research, and audit support

Analyzed actual and expected net revenue and interim payments from payors to accurately report net revenue

Education

Madison Park Vocational High School

oHigh School Diploma achieved

References

References are available on request.

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