April Mitchell

Louisville, Kentucky

502-***-****

ad26w4@r.postjobfree.com

Education

**** – Current

AAS Health Information Technology

Jefferson Community Technical College

Professional Experience

Baptist Healthcare, Louisville, Kentucky 2013-Current

Claims Analyst

Review charges, and use of claim or denial rejection codes within established guidelines and standards, correct and clear all claims edits including NCCI and coding edit errors

Correct OCE and NCCI APC edits for Medicare/Medicaid/Commercial claims

Investigate and resolve suspended claims, verify diagnosis codes are coded correctly (ICD-10)

Compile and analyze claims data and perform related duties including tracking trends, noting patterns, and detecting irregularities

Interpret medical reports to apply appropriate ICD-10, CPT, and HCPCS codes to submit claims for payment

Communicate with all departments of the hospital to review rejections and unbillable charges

Review claims for End Stage Renal Disease to determine if related or not related

Add covering diagnosis to Medicare denials, local coverage denials, and national coverage denials

Baptist Healthcare, Louisville, Kentucky 2007-2013

Reimbursement Specialist

Applied policy and provider contract provisions to determine if a claim is payable, if additional information is needed, or if a claim should be denied

Documented, tracked, and resolved all plan providers' claims projects

Oversaw advanced claim inquiries and assisted claims staff with responding appropriately as needed

Answered client/patient questions to ensure understanding and client/patient satisfaction or referred them to senior level staff

Served as a liaison between numerous internal departments, including customer service, accounts payable, legal, and others

Contacted commercial insurance for resolutions of contract payment errors, collected underpayments, tracked denials for trends and industry standards, acknowledged trends for contract negotiation

Baptist Healthcare, Louisville, Kentucky 2006-2007

Denial Auditor

Received, processed, and entered all denials into system

Provided clerical assistance to appeal process by letters and contacted insurance companies

Coordinated with five hospitals to track and evaluate their denials

Assisted with developing new processes for denials, including training hospitals on the new process

Assisted with balancing daily checks

Analyze claims and applied standards of federal regulations to ensure correct billing practices

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