Business Analyst Coding

TIFFANY FREEMAN

**** ********* **. ** ****, OK. *3036 · 405-***-****

Email: ********@*****.***

I am an analytical, dependable, self-organized and detail-oriented Coding Analyst who has had over six years of experience in the full spectrum of claim production. Collaborative team player with an ownership mentality and a track record of delivering the highest quality strategic solutions to resolve challenges, and propel business growth.

PROFESSIONAL EXPERIENCE

JAN 2024-MAY 2024

VICES BAR AND VENUE

BARTENDER

2015 TO DECEMBER 2023

Centene Corporation, LLC Farmington, Mo

Claim Analyst, Nov 2015-March 2016

Advanced Analyst, March 2016-Dec 2017

Coding Analyst, Dec 2017-May 2021

Business Analyst II May 2021-current

Claims Analyst

A claims analyst is responsible for investigating and analyzing insurance claims to determine their validity and coverage. This may involve reviewing medical records, interviewing witnesses, and evaluating evidence. They also communicate with policyholders, healthcare providers, and legal counsel to gather information and resolve any discrepancies. Additionally, they may negotiate settlements and make recommendations for claims that require further review..

Advanced Analyst

Resolve complex claims, claim appeals, inquires, and inaccuracies in payment of claims.

Review and maintain appeal work baskets so they are processed in a timely manner.

Assists supervisor and team leads to research and determine status of medical claims to ensure they are consistent with work processes and CMS guidelines.

Traveled to Tempe, AZ to assist with training of a new site.

Mentored new and advanced analyst throughout training.

Backup Team Lead.

Assist in creating work processes for the department and support team members in understanding changes in work processes.

Primary contact for the team when the lead is out, for the plan and for other departments in researching, collecting information and documentation to address various issues.

Maintained daily reports and monitored inventory daily.

Assigned worked and tasks to other analyst as needed.

Reviewed claims manually processed to ensure accuracy prior to check run.

Review IA and QRT errors to track and identify trends.

Analyzed trends in errors identified and compiled reports to provider management with results and possible solutions.

Coding Analyst

Review and process high dollar claims for appropriate place of service, length of stay, match to authorization, and possible outlier DRG or stop loss pricing.

Review provider contracts and ensure the claims were processed according to their contract to avoid provider abrasion.

Conduct complex business and operational analyses to assure payments are in compliance with provider’s contract; identify areas for improvement and clarification for better operational efficiency.

Work collaboratively with various cross-functional departments to determine appropriateness of pricing.

Work collaboratively with Medical Management Department to resolve any issues with medical review notes that effect high dollar claim pricing.

Serve as a technical resource/coding subject matter expert for contracting pricing related issues.

Responsible for entire cycle of high dollar claims which includes verifying information on submitted claims, reviewing contracts, compliance guidelines, state regulations, eligibility, and authorizations to determine reimbursement, and releasing claim for payment.

Business Analyst II

Collaborate with the claims department to price pended claims correctly.

Audit check run and send to the claims department for corrections.

Analyze trends in claims processing issues and assist in identifying and providing solutions.

Research providers’ claims inquiries as needed and provide resolution.

Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication.

Mentored new hires to assist in training and demonstrated new concepts to the team.

Document, track and resolve all plan providers’ claims projects

specialists with system knowledge, de- escalation techniques, and customer escalations.

Assisted assigned supervisors and/or managers with daily processes including call monitoring, directing the training of new Engagement specialist, and providing quality assurance assistance..

EDUCATION

MAY 2018

ASSOCIATES OF APPLIED SCIENCE

OFFICE SYSTEMS TECHNOLOGY – MEDICAL CODING

Mineral area college, park hills, mo

GPA: 3.4/4.0

SKILLS

Compliance

Microsoft word & excel

Spreadsheets

Exceptional oral and written communication

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