Senior Technical Business Analyst
Resume:
KELLEY D. JONES
Midland, VA 22728
*************@*****.***
CAREER SUMMARY
Energetic, detail-oriented Healthcare Revenue Analyst with extensive experience in medical billing, charge capture, credentialing, and building coding software. Well versed in the workings of the Healthcare Revenue Cycle. Strong focus with capturing revenue, with professional attitude for appropriate charging of patients. Core competencies include:
Coding Software Ruler Writer
Psychiatry Billing
Coding Software Tester
Facility Credentialing
Revenue Cycle Knowledge
Individual Provider Credentialing
Facilitator/Trainer
Charge Capture
PROFESSIONAL EXPERIENCE
NUANCE COMMUNICATION, INC. Burlington, MA 2013-2015
Senior Technical Business Analyst - Remote
Conferred with systems analysts, engineers, programmers, and others to design computer assisted coding (CAC) software product, completed ICD-9 build on Tessi Engine.
Modified existing software through a rule writing process on an excel spreadsheet, to correct errors and improve its performance in Consolidated Engine for dual coding of ICD-9 and ICD-10.
Validated suggest codes for direct software system testing and simulations to validate procedures, programming, and documentation flow.
Used actual client electronic documents submitted through the Natural Language Processor, and followed clients guideline standards for coding and billing.
Mapped ICD-9, ICD-10, and, CPT-4 codes to SNOMED CT codes for creation of CAC software product.
Assisted remote team members with solving technical issues that arose as liaison between managers and team members.
NOVANT HEALTH PRINCE WILLIAM MEDICAL CENTER Manassas, VA 2001-2013
Revenue Cycle Analyst 2008-2013
Identified and abstracted data from emergency room and outpatient infusion records for charge capture using LYNX software, producing an immediate increase in revenue.
KELLEY D. JONES Page 2
Compiled denial reports through MedAssets to resolve conflicting, missing, or unclear account information. Efforts decreased denials by 85% making for more efficient billing practices.
Used Centers for Medicare and Medicaid Services guidelines and updates to keep Charge Description Master (CDM) current for charging to keep the facility from fraudulent billing or fines.
Maintained credentialing for facility and individual providers to ensure 100% billing of services.
Trained all new charge capture team members and facilitated educational activities to maintain credits for certifications.
Appointed liaison between departments of hospital to capture charges and relay CDM updates and changes.
Safety Sitter 2010-2013
Billing & Credentialing Specialist 2003-2008
Administrative Assistant 2001-2003
TRI-MED BILLING SOLUTIONS, INC. Midland, VA 2003-2008
Co-owner Medical Billing Company
Provided full spectrum of psychiatry billing and coding services for five private practice
psychiatrists and therapists.
Trained psychiatrists and therapists on how to bill and code for their patients on the individual insurance websites.
EDUCATION & CERTIFICATION
Master of Health Administration/Informatics University of Phoenix - GPA 3.87
Bachelor of Science in Health Administration/Emergency Management
University of Phoenix - GPA 3.67
CPC, Certified Professional Coder, American Academy of Professional Coders
Corporate Training:
JIRA – Issue and Project tracking software
ORCA – Online tool for rule and code analysis
SNOMED CT Cliniclue
ICD-10 Educational Program
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