Business Analyst Quality Assurance

REGINA A. WALKER

Glenolden, *****

*********@*****.*** 610-***-****

www.linkedin.com/in/reginawalker1

Action-Oriented Professional

An action-oriented professional with extensive success planning and implementing initiatives that align with employee development and team building for productivity with company goals. Highly efficient motivating team members, using organization skills and clear, direct communications. Productive employee, both in individual contributor and supervisory roles. Have excellent documentation skills, time management, and pay attention to detail. Knowledge of organizing information, and general math skills. Work closely with staff to identify and resolve and share information regarding department trends, guidelines, and any new updates. Prioritize and solve problems.

Formidable asset to any team!

Qualifications

Medical Billing and Coding

Talent Management Administration

Project Management

PowerPoint

Quality Assurance

Excel

Team Motivation

Leadership

Insurance Verification

Patient Care (CNA)

Training and Development

Safety & Security

PROFESSIONAL EXPERIENCE

Peco, an Exelon Company, Phila, Pa

Business Analyst I

(Mindlance Contract) 04/2023 – present

Responsible for handling inquiries from the general public in responding to irate customers, resolving difficult, challenging and/or sensitive issues with diplomacy, empathy, good judgement, patience, and professionalism.

Responsible for managing multiple accounts under pressure in a time sensitive, fast paced environment, while being organized and detailed organized.

Responsible for communicating effectively solutions to problems via telephone and written correspondence.

Responsible for computing mathematical and analytical inquires to be able to interpret data billing to customers.

AmeriHealth Caritas/Keystone First Community Health Services, Phila, PA

Durable Medical Equipment Specialist 12/2021 – 04/2023

Responsible for intake requests for Durable Medical Equipment including telephone support, data entry, submission to AmeriHealth Caritas Health Plan Medical Directors for medical necessity.

review, completion of service authorization detail lines, and member/provider notification

process.

Responsible for precertification and recertification process for Durable Medical

Equipment.

Follows departmental workflow for prior authorization of request including

documenting receipt of request, member eligibility, submitted information in the

AmeriHealth Caritas Health Plan Utilization Management software system.

Authorizes services based on AmeriHealth Caritas Health Plan Guidelines. If unable

to approve, submits the request to AmeriHealth Caritas Health Plan Medical

Director for medical necessity determination.

Completes detail lines in Utilization Management software system to reflect

authorization or denial of services.

Follows denial process to provide initial verbal/facsimile notification to

providers/members and generates appropriate written notification to

providers/members.

AmeriHealth Caritas/Keystone First Community Health Services, Phila, PA

Utilization Management Technician 11/2018 – 12/2021

Supports staff, providers, and vendors with daily operations.

Creates, updates maintains and/or closes authorizations or tasks for services as assigned within process guidelines.

Routes case to appropriate associates based on established guidelines.

Processes all incoming and outgoing correspondence/faxes in accordance with required standards and within respective timeliness guidelines.

Performs other related duties and projects as assigned within the assigned timeframes.

Home Helpers, Chester Heights, PA

Caregiver 01/2017 - 03/2020

Health, Wellness & Fitness

Provide companionship and comfort.

Provide assistance with activities of daily living.

Run errands & Shopping.

Assist people with physical challenges, those that may suffer with dementia or other mental.

disabilities at home and/or in a facility

Neighborhood Visiting Nurses Association, West Chester, PA

Accounts Receivable Medical Billing Specialist 01/2017 – 06/2018

Accounts Receivable

Create invoices/process payments for hospice & home health services.

Collections

Insurance billing/verification

Copay billing

Aging Reports/Claim Denial Investigations

Reconciliations

Other duties as related

Universal Health Services/Independence Physician Management, Malvern, PA

Accounts Receivable Specialist 06/2018 – 11/2018

(Aerotek Contract)

Perform eligibility and claim status follow-up inquiries utilizing outbound calls to the payer, web link tools and payer websites.

Effectively document claim status and next steps in the Practice Management System (PMS) to expedite timely and accurate claim processing.

Research claim denials by assigned payers in timely manner to minimize write-offs.

Proceed with the appeals process as needed.

Reprocess corrected claims for payment in a timely manner.

Identify root causes and denial trends.

Perform extensive and current working knowledge of government, managed care and commercial insurances, claim submission requirements, reimbursement guidelines, and denial reason codes.

Perform accurate and timely write-offs.

Define aging targets to meet collection criteria to minimize write-offs.

Neighborhood Visiting Nurses Association, West Chester, PA

Accounts Receivable Medical Billing Specialist 01/2017 – 06/2018

Accounts Receivable

Create invoices/process payments for hospice & home health services.

Collections

Insurance billing/verification

Copay billing

Aging Reports/Claim Denial Investigations

Reconciliations

Other duties as related

IRON MOUNTAIN, Collegeville, PA

Customer Destruction Specialist 04/2013 – 08/2015

Responsible for processing and creating incoming requests for destruction (email, fax, postal).

Create a repository for all communication between the customer and Iron Mountain with regards to the destruction orders, using system resources to ensure requester is authorized, order will bill properly, and whether the customer requires any special handling.

processing Preliminary Reports, sending to the customer for sign off/authorization, ensuring return receipt and/or following up with customer.

Responsible for any required maintenance of orders, also following up for subsequent authorization. (Functions as Strategic/Enterprise account support for local customer needs.)

Interacts with Supervisor, Manager and other departments for purpose of resolving customer concerns and needs.

Ensure all interactions with customers (both internal and external) are professional and courteous.

Ensure prompt completion of all service requests in accordance with service level agreements.

Support customer needs received through Account Management or other internal teams with regards to Destruction Order Processing.

Ensure data integrity and adherence to Iron Mountain policies and procedures.

National Naval Medical Center (NNMC) 05/2012 -07/2015

Worked as an apprentice for medical billing and coding – Bethesda, MD Department W

Extrapolation specialist-apprentice for medical billing and coding

Assisted on ICD 10 implementation

Used Electronic Health records

Review patient bills for accuracy and completeness and obtain any missing information.

Iron Mountain, Sharon Hill, PA

Imaging Production Supervisor 10/2009 - 04/2012

Managed staff of 17 production employees. Led quality improvement initiatives. Served as liaison between customers and internal staff.

Maintained productivity by adjusting schedules daily and cross-trained staff on all operations.

Improved new employee integration by organizing and implementing operations' segment of new hire orientation program that focused on policies, SOP's, processed and values.

Maintained employee productivity and commitment to quality by encouraging and facilitating involvement in process improvements and implementing applicable suggestions.

As communications liaison, identified critical logistics issues and recommended improvements in transportation processes, which helped increase put away time by 10%.

Managed the demands of a 100,000-image project requiring 2 full-time shifts while maintaining daily work requirements.

Ensured quality talent was available upon request, working diligently with temporary staffing agencies and human resources, as the communications liaison.

Received Honorable Mention for scoring 100% in service metric for 4 consecutive weeks in one quarter in 2011.

Iron Mountain, Sharon Hill, PA

Data Entry Coordinator 03/2002 -10/2009

Supervised staff of 12 data entry employees.

Provided consistently effective external and internal customer service while achieving labor ratio goals.

Assisted Operations Supervisor with the counseling process by monitoring attendance and productivity using PMT statistics, spreadsheet and charts, and daily reports.

Facilitated ongoing process improvement by continually monitoring performance and conducting daily huddle meetings with staff to discuss productivity, quality, and safety and security.

Trained 5 new hires, many temporary workers individually and cross-trained employees for development and to meet productivity goals.

IRON MOUNTAIN

Data Entry Specialist 11/1995 –03/2002

Performed data entry tasks and moved boxes to and from pallets as the files were checked. Used computer software such as DCS (Data Capture System) and Excel.

FIRST FIDELITY BANK, Upper Darby, PA

Customer Service Representative 03/1986 – 10/1994

Lead operator responsible for 20 employees in call center.

Provided service and information via telephone or correspondence.

Researched and solved customer problems and complaints regarding accounts.

Verified accounts, open/closed, loan applications, loan payments, process stop payments.

Cross-sold bank products and services when appropriate.

Selected to individually train two new hires as customer service representatives.

EDUCATION AND CONTINUOUS LEARNING

Full Circle Computing, Philadelphia, PA

Medical Coding and Billing Specialist

Red Cross House, Philadelphia, PA

Nursing Assistant Training – Certified(CNA)

Strayer University, Springfield, PA

Completed numerous courses, including: Business, Business Law, Sociology, Psychology, and Marketing

Delaware County Community College, Media, PA

Information Technology

Completed a variety of courses and seminars through employer, for example:

Safety Classes:

Fire Safety/Fire Extinguisher

Hazardous Materials

First Aid

Emergency Planning

Back Injury/Safe Lifting

Supervisor Training:

Coaching and Counseling

Performance Management Training (PMT)

Labor Laws (Unions included)

Workplace Violence

Sexual Harassment

VOLUNTEER WORK

American Red Cross

Disaster Health Services Team, Disaster Action Team

Contact this candidate