RICK JOSEPH SKREZYNA

*** **** ******* ****** **** #1306

Chicago, Illinois 60657

773-***-****

MT.SINAI & HOLY CROSS HOSPITAL 6/2018-Present

Utilization Management Analyst

The focus of Utilization Management is on appropriateness, effectiveness and quality of services provided to determine approval of medical necessity. Utilizing the three types which are initiative, concurrent and retrospective. The UM Analyst will review the dx and medical records and determine which correspondence is most accurate determination that will conclude that the patient is admitted as observation, inpatient, or observation turned to inpatient based on medical necessity. The UM Analyst must have a strong medical terminology background and many years of interpreting healthcare verbiage. UM Analyst primary goal is to obtain the initial authorization of services. Afterwards the UM Analyst will work closely with Case Management for additional authorizations for the duration of patient stay. The UM Management team works an endless lengths of faxes with determinations of approvals, denials, or additional information. In addition headlining calls from insurance companies with determinations or request for additional clinical. It is crucial for the UM Analyst to stay on top of all the above mentioned, particularly authorizations for revenue to be brought in. Several reports are also ran to assist UM Analyst to determine what's best suitable in appeals that are worked based on medical necessity by an RN if an authorization is denied. BEST HOME HEALTHCARE NETWORK 3/2016-12/2017

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Revenue Cycle -Credentialing

Ensuring that healthcare providers meet client facility and accrediting agency standards. Review credentialing files and work with healthcare providers to obtain missing, incomplete and expiring items and resubmit corrected information to prevent any denials of medical claims . Knowledge of different type of providers from M.D. to Mid Level Provider in order to accurately complete new enrollment or renewal of applications. Maintain consistent contact with Northwestern HealthCare providers to ensure that expectations are clear and requirements are completed in a timely manner. Established and maintained long-term working relationships with healthcare providers and Department Administrators to ensure positive relationships. Worked with government payers such Medicare & Medicaid to complete revalidation for reinstatement. Knowledge of MSOW, EPIC, EPIC, Professional Licensing and NPPES so that all providers NPI, TPAN's and other provider's certification and demographic information is accurate and up to date. Utilized advanced problem solving skills to resolve development issues and conflicts that may arise between provider and payer looking for various trends of denied claims thus working closely with A/R department to have claims rebilled correctly with managers involvement to restructure of claims processing. International billing and collecting such as Qatar, Kuwait, for services billed independently or to the Embassy with follow up communication for services rendered by Northwestern Memorial Hospital.

NORTHWESTERN MEMORIAL PHYSICIANS GROUP – Chicago 2006-2014 Corporate Finance Analyst

Assign correct billing to either company, insurance or directly to Employer. Determine accuracy that all charges are loaded in correct bucket. Oversee Executive Health charge entry with 24-48 hours of receipts. Maintain professional and ongoing responsive communication particular with collecting on Executive accounts, which is a customized VIP day of care usually paid by the company. Assist in coordination of Executive's full day of care with clinic, Northwestern Memorial Hospital and various other clinics that was selected by the Executive. Oversee A/R reporting and spreadsheets for management team. Identify problematic A/R accounts with management team to have invoices paid with companies contract guidelines Creation of invoices to be sent to Companies. Maintain A/R receivables spreadsheets for monthly collection on high dollar A/R from Executive Health Program by employers within a diplomatic process thus ensuring healthy relationships with company contacts and issue corporate refunds. In addition responsible for Coding encounter forms for physician billing for Northwestern Wellness Program. Follow up on A/R denials and resubmit according to EOB such as modifiers, submission of medical records, proof of timely filing, etc. Check on Credentialing status with a pattern of denied claims from termed providers contract and report to Credentialing and or Contracting Dept. Create monthly reports for A/R aging reports using Touchpoint Database, process insurance refunds and work to identify non covered claims that are billable to patient such as cosmetic, non covered weight loss benefits, non covered massage therapy, and other non covered wellness benefits per the patient's healthcare plan.

NORTHWESTERN MEMORIAL HOSPITAL - Chicago, Illinois 2003 - 2006 Sr. Financial Assessor/Transplant Dept

Maintain accurate and timely follow-up on reimbursement per payer contracts. Track transplant clinical dates to facilitate accurate billing. Develop spreadsheets to reconcile specific payer account to ensure accuracy of patient’s current transplant phase inclusions and payments. Obtain professional fees for global contracts. Identify and update correct insurance coverage. Collaborate with payer to discuss and resolve any payment problems. Challenge denials and rejections from payers or TPA party on which claims are considered non transplant related and work account diligently to collect these payments. Work with clinical team to distinguish between disease management and transplant related claims and bill appropriately depending on correct phase on the patients transplant status . Audit accounts to determine stop loss and/or underpayments. Knowledge of contractual language to ensure accurate reimbursement by challenging insurance companies that do not reimburse correctly per the patient's benefits plan. Identify patient transplant termination phase and resubmit all denials back to insurance that fall under disease management and not transplant. Review any overpayment request and refund as appropriate. Attend payer meetings to discuss strategic planning on timely and correct reimbursement according to new contracts, revised contracts and single case letter of agreement.

NORTHWESTERN MEMORIAL HOSPITAL - Chicago, Illinois 2002 - 2003 Sr. Financial Assessor/Manage Care

Claim follow-up for Manage Care payers on A/R recurring accounts. Challenge denials and work appeals on services that do not fall under recurring conditions Collection of reimbursement according to payer contract. Work on appeals with claims that were processed erroneously by insurance companies or TPA. Document all pertinent information into Primes database and tickle account for next follow up date. Meet productivity and quality goals in recognition and input of Stockamp Guidelines Collection Process. Reported troublesome or unsolvable claims to the Auditor or Contractor after several attempts made to the insurance company to pay per patient benefit plan. Requested overturn on insurance denied claims based on contractual language or medical necessity.

RESURRECTION HEALTHCARE - Chicago, Illinois 2001 -2002 Insurance Coordinator

Sr. Financial Assessor/Manage Care

Claim follow-up for Manage Care payers on A/R recurring accounts. Challenge denials and work appeals on services that do not fall under recurring conditions Collection of reimbursement according to payer contract. Work on appeals with claims that were processed erroneously by insurance companies. Document all pertinent information into Primes database and tickle account for next follow up date. Meet productivity and quality goals in recognition and input of Stockamp Guidelines Collection Process. Reported troublesome or unsolvable claims to the Auditor or Contractor after several attempts made to the insurance company to pay per patient benefit plan. Requested overturn on insurance denied claims based on contractual language or medical necessity. UNITED HEALTHCARE OF ILLINOIS - Chicago, Illinois 2000 - 2001 Provider Inquiry /Customer Service

Verified benefits and eligibility on provider queue line. Answered provider questions on claim status and other issues pertaining to reimbursement to providers. Submitted claims that were processed in error or if additional information was needed. Submit verbiage back to claims processor on claims that were denied in error per the patients benefit plan. Follow up with providers on unresolved issues that has been resubmitted back to insurance company identify what resolution has taken place such as corrected coding with CPT, ICD-9, modifiers, etc. Detailed explanation on denials to providers based on patient's benefit plan which may include interpretation of EOB'S. UNITED HEALTHCARE OF ILLINOIS - Chicago, Illinois 1996- 2000 Billing & Enrollment Customer Service Coordinator

Serviced Managed Care Groups, Brokers, Agents, Group Employers, & Medicare Recipients on queue line regarding enrollment, billing, claims, contractual language, eligibility & benefits, terminations and claim denials. Reconciled group premiums for any credits or debits based on new company employees added to United HealthCare monthly roster and made necessary correction on any credits of missed premium fee's. Credentialing status on pattern of denied claim from providers with clinical sites and bring awareness to Credentialing Department. Processed batched correspondence new employees, dependants, spouse, and other dependants that fall under a qualifying event. In addition processed a monthly reports on Medicaid Recipients that has switch to United HealthCare HMO plan by our sales team. Calculated monthly commission report for UHC sales team.

FAMILY CARE OF ILLINOIS - Chicago, Illinois

Billing Coordinator 1995-1996

Coded activities for billing submission. Created and maintained spreadsheets for A/R . Processed reports submitted to me by case management to add members and coding on what types of services were provided to members of DCFS. Reconciled billing errors and discrepancies .Corresponded with staff, DCFS, & Public Aid. THRESHOLDS MENTAL HEALTH AGENCY- Chicago, Illinois Billing Coordinator 1993 - 1995

Organized and reviewed Medicaid/Medicare billing. Entered billing data into software meeting monthly deadline goals. Tracked and Audited charges to accurately bill within the correct Mental Health Programs such as youth, deaf, homeless & elderly programs. Prepared special reports and accounts receivable spreadsheets. Reconciled billing SOLUM & HOPPER- Chicago Heights, IL 1991-1993

Legal Assistant

Answer phones and make appointments. Processed written reports into Word Processing. Organize and analyze information for billing clients. Organize and track case files and attend to mail and faxes. Act as personal assistant to Attorney's daily errands outside of office duties.

FSC PAPER COMPANY - Alsip Illinois 1989-1991

Purchasing Clerk/Runner/Receiver

Assist in purchasing of paper mill commodities, office supplies,etc. Data Entry of purchase orders into Database. Liaison with other departments on questions that may arise with purchase orders. Review inventories and order as required. Track the status of any orders. Interact with the suppliers on a day to day basis and maintaining professional and trusting relationships. Act as a runner to make bank deposits, inter office mail deliveries, picked up various time sensitive orders using company vehicle and deliver to appropriate department. Act as back up Receiver in the Paper Mill Receiving Dept. TRUMAN COLLEGE - Chicago, Illinois 1995 - 1995

Concentration - Medical Terminology I

PRAIRIE STATE COLLEGE - Chicago Heights, Illinois 1987 - 1987 Semester of Study abroad program - London, England Concentration - Business & English Literature.

PRAIRIE STATE COLLEGE - Chicago Heights, Illinois 1987 - 1989 Concentration – Business