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Management Microsoft Office

Location:
New York, New York, United States
Salary:
85000.00
Posted:
January 03, 2017

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Dannethia Little

acx3r4@r.postjobfree.com

C ellular: (7 04) 241-2276

Health Insurance Business Analyst

Health Insurance Business Analyst professional with proven abilities in Health Care Fundamentals, Quality Control and Problem Resolutions. Possess extensive knowledge of insurance products including PPO, HMO, Network Access, Medicare, Medicaid and Supplemental Benefits. Comprehensive understanding of Outpatient medical payment methodologies and a thorough knowledge of CPT coding. Key Skills and Experience

Healthcare Fundamentals ● EPIC ● Payment Methodologies Application Lifecycle Management (ALM) ● Softheon QA ● Microsoft Office Fastrak ● Production & Prototype Systems ● Mainframe Staff Management ● Communications

Professional Experience

EmblemHealth formerly Group Health Inc. 2004 - 2016 Senior Business Systems Analyst

● Develop strategies to increase approver’s performance (i.e. production, quality, etc.)

● Analyze and evaluate existing or proposed systems methods and procedures devising computer systems to process data.

● Work in conjunction with other operating units to analyze results and identify areas for process and quality improvement while providing timely feedback to the appropriate management staff.

● Develop alternate system approaches recommending changes/enhancements where necessary and loading and maintaining contract files.

● Conduct studies analyzing user/systems requirements and their benefits controls.

● Support the Director and Vice President of claims operations in recommendations for system improvements/enhancements for the processing of 837I and 837P transactions

● Responsible for creating and maintaining project documentation (reporting, meeting minutes, etc.)

● Track and monitor/update task plans for all projects and provide weekly progress reports to management.

● Communicate with Provider relations with regards to Medical Providers’ access to the system Group Health Inc. New York, NY 1990 – 2004

Senior Claim Supervisor

● Responsible for performance and resource management of examining staff handling new claims inventory, mail correspondence, appeals, special handling and other request. Plan and control all aspects of aging inventories as well.

● Ensure that all claims are processed accurately and timely in accordance with regulatory and corporate requirements.

● Experience with effectively supervising a staff of approximately 50 + claim approvers.

● Monitor processing of outpatient claims as it relates to Medical pricing with the use of CPT codes and RBRVS values.

● Responsible for the production of new policy and procedure manuals to improve claims turnaround time

● Present and report on daily/weekly status on approver production and inventory levels to the Senior Claims Management Team. This includes meeting timely with rotating staff and presenting results on performance (e.g. Weekly and Quarterly Progress Reports, etc.

Other Experience

● Business Requirements Document (BRD)

● EPIC

● Background in hands on leadership and supervision in the areas of staff development

● Test Plans

● Involvement in the implementation of customer/ user relations and comprehensive problem resolution.

● Extensive customer and vendor contact.

● Familiar with ICD-10, CPT and coding and medical terminology.

● Computer Literate-Project & Portfolio Management Center, Quality Center, Emdeon Business Services, EMC System, Siebel System

Education

Masters of Science in Administration

Central Michigan University

Information Security System/ AWS Training

LMS- Per Scholas

Bachelors of Science

College of New Rochelle

Health Insurance License

POH Institute



Contact this candidate