Account Relationship Manager Contracts and Systems Analyst Claims Manager

PROFESSIONAL SUMMARY

Senior Account Relationship Manager and Analyst with 20+ years of experience of managing existing client relationships and growing new client accounts across the payer and provider sides of the health care industry. Recognized as a goal oriented and results-driven leader, with outstanding communication, teamwork, organizational expertise and analytical skills. Expertise in streamlining and standardizing procedures to strategically achieve client goals. Seeking a professional role with an industry leader committed to growth, customer satisfaction and operational excellence.

PROFESSIONAL EXPERIENCE

Change Healthcare / EquiClaim Lombard, IL (Remote Atlanta area) 2012 - Present

Senior Contract Compliance Analyst

Produce Compliance and adherence of established policy and protocol in effort to minimize internal waste by means of conducting QA.

Promote increased revenue by minimizing contract related claim fall out through analysis, validation, and reporting of trends, patterns, and errors in statistical reporting.

Build Account Management relationship and team rapport to maintain direct contact to and from Account Management Team regarding any client contract related obstacles/issues.

Account Analyst II

Account management for the client relationship between EquiClaim and United Healthcare.

Analyze and manage client data related to DRG, Medical Necessity and Hospital Charge Audit programs.

Manage direct client requests and inquiries related to audit programs.

Manage daily claim data file manipulation and submission to client, client/provider contract interpretation in relation to provider audit programs, extraction and analysis of claim data.

Verify audit results and claim selections, submit to the client

Prepare and validate reports to display results and audit trending.

Claricon, LLC Lisle, IL 2008 - 2012

Systems / Contract Analyst

Analyze and manage client contracts, fee schedules and claims databases to ensure proper reimbursement per policy provisions.

Interpretation and implementation of client contracts and researching claim trends.

Designed Access based queries to extract and analyze data and preparing reports to display results.

Liberty Mutual Schaumburg, IL 1999 - 2000

Claims Case Manager

Manage, investigate and resolve liability claims on a national level.

Research basis of claims, providing a liaison between clients and claimants.

Apply knowledge of policy coverage and legal liability on an individual case basis.

Customer service lead, facilitating the resolution of claims.

American Chambers Naperville, IL 1992 - 1999

Claims Adjuster

Adjudicated health and life insurance claims for policy holders.

Investigated eligibility for coverage, applying policy provisions to claims, and conducting medical record reviews to lead to the resolution of claim submissions.

Fraud Analyst

Investigated fraud claims against policy holders and providers.

Conducted extensive research to determine validity of claim status through policy provisions and utilization of organizational and analytical skills.

Information Management Analyst

Implementation lead for installation of new computer system for the claims department.

Analyzed data, providing a liaison between programmers and claims representatives, tracking issues and subsequent resolutions related to the system.

EDUCATION, CERTIFICATION, TECHNICAL and CORE SKILLS

EDUCATION

Northern Illinois University DeKalb, IL Bachelor of Arts, Psychology 1992

CERTIFICATION

•Lean Six Sigma Certification - White Belt - Management & Strategy Institute 2019

TECHNICAL SKILLS

•MS Office Suite

•Access DB

CORE SKILLS

•Project Management

•Articulate communication

•Detail oriented

•Team leadership

•Strategic thinking

•Data analysis

•Process improvement

•Customer service

•Strategy and planning

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