Financial Analyst Customer Service
Resume:
MD
OBJECTIVE
Seasoned and enthusiastic
Medical Analyst Professional
with a passion to lead, inspire
and develop. Possess
advanced customer service
skills, specializing in medical
billing techniques for
OB/GYN, Nursing Homes,
Home Healthcare, Ambulance,
Orthopedics and Plastic
Surgery.
SKILLS
● Athena
● Salesforce
● Medisoft
● Eclinical
● ADP
● Medicaid
● Veri Net
● Centricity
● Meditech
● LTC
● Navicure
● NextGen
● AMS
MERCEDES DALTON
MEDICAL FINANCIAL ANALYST
***********@*****.***
MCDONOUGH, GA
EXPERIENCE
LEAD PAYMENT ANALYST • PEACHTREE ORTHOPEDICS • 10/2018 – 012/2024
● SME in revenue cycle management via claim generation, submission, adjudication, payment posting, reconciliation, patient billing, refunds, adjustments, denials, compliance & auditing, and follow-ups.
● Back up liaison for work coordination, education, training, and quality improvement within current and new team members
● Conduct reporting & analytics to monitor revenue cycles, identify trends and collect all relevant financial and payment data.
● Conduct root cause analysis such as overpayments, data cleaning, categorize overpayments to maintain financial integrity to ensure payment processing operations are efficient.
● Analyze accounts end to end of fee schedules, correct billing, EOBs and refunds
INSURANCE CLAIM FOLLOW UP • HR CONTROL SOLUTIONS • 06/2016 – 09/2018
● Accountable for the resubmission of primary, secondary, and tertiary claims regulations and policies.
● Communicated with third-party representatives as necessary to complete claims processing, reconciliation, vendor management, reporting to resolve problem claims.
● Handled reporting shared to key stakeholders but not limited to quality assurance, regulatory compliance, and settlement negotiation.
● UB & HCFA
Claims/Billing
● GHP Portal
● HISS Optum
● Encoder
● ePrimis
● Veri Net
● AS400
● MedWare
● Allscripts
● IDX
● Gateway
● Epic
● Intergy
● Availity
● Navinet
● Followed-up daily on post processing activity including but not limited to, rejected billing, adjustments, rebilling, and denied claims for accounts greater than 30 days old.
● Maintain receivable financial accounts by intake and documentation, evaluation, and payment authorization. BILLING MEDICAID • PRUITT HEALTHCARE •02/2015 – 05/2016
● Experience with billing process management for all payer types including commercial, governmental such as Medicare, VA, Medicaid, private insurance, etc. with the ability to cross-over into different payers.
● Trained staff in basic Medicaid/Medicare billing rules, regulations, collections and deadlines.
● Knowledge of contract interpretation, hospital billing requirements, compliance, reporting and system upgrades.
● Verify insurance coverage to confirm billing procedure and appropriate contracts, budgeting, and invoicing.
● Assisted in projects with key stakeholders such as The Corporate Office of Financial Staff to lead the charge on new initiatives and process improvements.
● Grady Memorial Hospital (Contract) Cash Poster
February 2013 - January 2015
● Plastikos Surgery Center Surgery Scheduler
January 2010- January 2013
● Forum Nursing Home Group Billing /AP/ Payroll Mgr July 2005 - December 2009
2
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