Quality Assurance Medical, SQL queries, Report Writing, Systems Admin

Sean L. Burton

**** ******* ** ****: 804-***-****

Glen Allen, Virginia 23060 ****.******@*******.***

CAREER PROFILE

Nine years experience in healthcare billing with proficiency in EDI transactions and systems administration

Three years experience with SQL writing queries and views to produce necessary data in Microsoft SQL Server Management Studio (SSMS)

Three years experience database reporting in Crystal Reports 11.5 linking tables, selecting appropriate fields, and writing formulas to create custom designed reports

Proficient in ad hoc, financial analysis, and quality assessment reporting

Experience in building and managing data tables in a Microsoft Access database

Ability to communicate/translate with technical and non-technical personnel

Experience in project management with high analytical ability

TECHNICAL SKILLS

Advanced knowledge of healthcare billing systems and software

Microsoft Word, Excel, and Access

Crystal Reporting 11.5

SSMS

RELEVANT PROFESSIONAL EXPERIENCE

Richmond Ambulance Authority, Richmond, VA

Responsible for managing the process workflows and overseeing the quality and production of a team of 6 medical coders

Supervisor of Reimbursement 02/2014 to Current

Manage the automated healthcare billing system and web-based Systems-As-A-Service (SAAS) as the systems administrator for the Reimbursement Department

Responsible for developing efficient process workflows and strategies for maximizing reimbursement

Manage Electronic Data Interchange (EDI) transactions and troubleshoot any issues

Manage and supervise a team of 6 medical coders

Run queries and create views using SQL Server Management Studio for data analysis and report developing

Create and manage customized reports using Crystal Reporting to for financial analysis, insurance denial review, tracking productivity and quality assurance feedback

Apply systems analysis techniques to ensure requirements are met and issues are resolved

Act as liaison between Reimbursement and IT departments and software vendors

Conduct audits on medical coding quality followed by the necessary training to the staff

Reimbursement Systems Analyst 04/2011 to 2/2014

Used SSMS to run queries and create views for data analysis and report developing

Used Crystal Reporting to create and manage customized reports for financial analysis, insurance denial review, tracking productivity and quality assurance feedback

Applied systems analysis techniques to ensure requirements are met and systems issues resolved

Managed the implementation of the ANSI 5010 conversion

Implemented new electronic archival system to improve department efficiency

Assigned user access and roles for all billing and web-based SAAS systems

Charge Entry Analyst Lead 04/2006 to 04/2011

Coded ambulance claims using ICD-9 and CPT codes to provide accurate billing to insurance, facilities, and patients

Managed electronic transmissions of claims and remittances.

Developed daily reporting documentation to monitor payer trends for reimbursement forecasting

Trained employees on medical coding procedures

ADDITIONAL WORK EXPERIENCE

Auditor of Public Accounts, Richmond, VA 2002 - 2006

Worked four years as a procurement specialist ordering supplies, furniture and computer equipment.

EDUCATION

B.S. in Computer Information Systems – Healthcare Informatics Expected Fall 2015

Walden University, Minneapolis, MN

B.S. in Computer Science Fall 1996 – Fall 1998

University of Richmond, Richmond, VA

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