Financial Analyst

Cvijeta Smiciklas

***** ****** ***** **

North Royalton, Ohio

44133

Home 330-***-****

*********@*****.***

OBJECTIVE

Seeking a challenging and responsible opportunity where experience and education can be combined to deliver profitable results.

PROFESSIONAL SKILLS

Personal initiative, practical experience and education are the foundation for superior performance in the following areas:

Develop training documentation and communication for the Admission Notification Program. Created policy and procedures for the claims department. Trained staff at the Cleveland Clinic in the implementation and claim payment process and coding on the TOPPS system. Provided continued support post live as necessary. Created reports and analysis to management. Extensive coding classes CPT & ICD10, Maintained Medicare’s RBRVS database. Pre-Existing investigation. On-line Claims Processing AS400, Mainframe, Crystal Reports. Patient accounting, benefits verified, processed appeals, billing and collections MS Office.

EDUCATION

oMedical Terminology

oHigh School Diploma

oHIAA & ICA Insurance Classes

oState of Ohio Accident, Life, Health and Annuity License

oExtensive CPT & ICD-9-CM Coding Classes

WORK EXPERIENCE

University Hospitals Health Systems

11100 Euclid Ave

Cleveland, Ohio

(2008 to present)

Residency Data Analyst

Financial Analyst II

Responsible for administration and maintenance of the Medicare reimbursement database (T.R.A.I.N). Responsible for 95 teaching programs. Oversee 45 program coordinators to ensure timely and accurate rotations to maximum allowable reimbursement. Medicare and Medicaid billing for a 100 million dollar teaching program. Responsibilities include educating/training residency coordinators. Prepare contracts / group agreements between UH and other hospitals. Provide support for Graduate Medical Education (GME). Conduct and report quarterly reviews. Prepare work papers for Medicare and Medicaid Cost Reports and provide support for Medicare and Medicaid audits.

Maintains Policies and Procedures relative to Medicare and Medicaid. Provide support on an on-going basis to supervising physicians. Analyzes data for quarterly invoices to other hospitals for resident services and reconciles to hospital general ledger. Work with GME and legal office to facilitate the execution of Affiliation Agreements to non-hospital sites. Verifies resident rotations to non-hospital sites, and reviews payments to the physician resident supervisors. Prepares affiliated group agreements with other hospitals. Conducts GME-related educational seminars for educational coordinators and GME staff. § Prepares IRIS and other GME related work papers for Medicare Cost Report in a timely and accurate manner. Provides supporting documentation for cost report audits. Negotiates with other providers for resolution of resident duplicates. Assists in preparation of annual resident budget. Maintains a working knowledge of government regulations related to GME. Demonstrated knowledge of graduate medical education programs. Proficient PC skills, including MS Office products, especially Excel and Access. Strong interpersonal skills and excellent communication skills, written, verbal, and organizational skills with great attention to detail.

University Hospitals Health Systems

11100 Euclid Ave

Cleveland, Ohio 44114

(12-5-2005 / 4-15-2008)

Senior Physician Relations Coordinator /Team Lead

Supervise Physician Relation Coordinators. Act as a liaison between patients and the healthcare organization for resolutions to questions, complaints and concerns. Coordinates physician and hospital services for referring physicians and with all UHSC clinical departments and hospital clinical services and related system members. Non-clinical community and marketing initiatives to improve familiarity with UHC/UHHS and increase referral. Plan organizes, prioritize and maintain workflow to facilitate departmental goal-to enhance relationships resolve contract issues and increase referrals. Develops training documentation and communication for the Admission Notification Program. Create reports and analysis on department operations. Maintain physician profiles in MSM and Database (Access). UH4CARE marketing lines .Patient scheduling. Microsoft Office, Windows XP, Excel, KRONOS and Oracle systems.

Medical Mutual

2060 East 9th Street

Cleveland, Ohio

(1982 to 1990)

Sr Claims Specialist

Provider Individual group contracting, and managed care credentialing. Negotiating fee for serviced DRG (case rates), Per Diem etc. Contracts. Knowledge of various reimbursement rates for inpatient stays, home infusion &home care, free standing ambulatory surgery centers. Research and resolve contract issues. Interacts with all levels of management. File maintenance of provider files and contracts. Employee benefits, reviewed medical records for pre-x conditions. POS, HMO, PPO, Dental, WC, State of Ohio, Medicare and Medicaid Claims, Billing and collections. And a strong understanding of underwriting policies and process. Strong communication and problem solving skills working with all levels of management. Performed claims audits, verified billing and coding accuracy in regards to and Appeals for Medical, Dental Exceptions, and benefits verified according to the policy provisions, Provider and member issues resolved regarding billing and benefit issues. COB, Customer Service for providers and members. Managed the installation of TOPPS claim payment system. Created policy and procedures for the claims department. Trained staff at the Cleveland Clinic in the implementation and claim payment process on the TOPPS system. Provided continued support post live as necessary. Created reports and analysis to management.

Summa Care

525 West Market Street

Akron, Ohio 44145

(1992to 1997)

Sr Claims Specialist /Physician Relations Specialist

Provider Individual group contracting, and managed care credentialing. Negotiating fee for DRG (case rates), Per Diem etc. Contracts. Knowledge of various reimbursement rates for inpatient stays, home infusion &home care, free standing ambulatory surgery centers. Research and resolve contract issues. Interacts with all levels of management. File maintenance of provider files and contracts.

Employee benefits, reviewed medical records for pre-x conditions. POS, HMO, PPO, Dental, WC, State of Ohio, Medicare and Medicaid Claims, Billing and collections. And a strong understanding of underwriting policies and process. Strong communication and problem solving skills working with all levels of management. Appeals for Medical, Dental Exceptions, and benefits verified according to the policy provisions, Provider and member issues resolved regarding billing and benefit issues. COB, Customer Service for providers and members. Managed the installation of TOPPS claim payment system. Created policy and procedures for the claims department. Trained staff at the Cleveland Clinic in the implementation and claim payment process on the TOPPS system. Provided continued support post live as necessary. Created reports and analysis to manage

Individual and group physician contracting, problem solving of contract and payment issues.

Physician credentialing and contracting process. Manage the credentialing process for new physicians and groups. Collect, analyze verification information and documents. Verification and database maintenance. License, DEA, malpractice insurance, board certification (verification) in accordance with all applicable regulatory standards.

Central Reserve Life

18900 Royalton Road

Strongsville, Ohio 44134

(1990 to 1992)

Claims / Customer Service Rep

Provide Customer Service in regards to claim payments, benefit questions and verification of benefits.

Coding and on-line claims processing on the Thor system, special projects and testing to improve the processing of claims, problem solving and research of claims. Provider Relations,Referrals, Group and Non Group, State of Ohio, Workers comp, Cobra, FMLA and Medicare experience, and all procedures of claim processing.

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