Financial Data & Denial Escalation Analyst
Resume:
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Evelyn (Evey) MacLeod
Orange Park, FL 32073
AHIMA – American Health Information Management Association Objective
Experience
To bring a strong work ethics while working equally with a company to ensure their success. I’m dedicated to teamwork, self-motivation and the attainment of corporate initiatives.
2/2020 – Present
Technical Analyst – 3D\PHQW &RPSOLDQFH Denial Escalation Assists in the development of financial data collection and measurement tool with respect to oversight of the Denial Escalation Dispute resolution process SSC Payment Compliance teams.
Works with denial Escalation manager to effectively identify and communica issues related to Dispute Resolution inventory
Facilitate the monthly logging and review of Dispute Resolution Denial Escalation inventory
Validates Dispute Resolution Denial Escalation Inventory Performs operational reviews of Denial Escalation Inventory between
$10,000 - $25,000 on a monthly basis, completing the reviews accurately and timely.
Assists with field communication, providing updates, and resolving issues Assists with preparation and coordination of communication and monthly calls with SSCs as needed
Practice and adhere to the “code of Conduct” philosophy and “Mission and Value Statement”
Other duties as assigned
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10/2011 – 04/23/2012 HCA Shared Service
1500 OSG Collections Specialist
Responsible for the BCBS inventory for all pools
Contact payer and initiate request for payments
Perform second validation of discrepancy reason code Escalate contract issues to the Supervisor
Practice and adhere to the ‘Code of Conduct’ philosophy and ‘Mission and Value statement’
Responsible for identifying several system issue that result in cash recovery, claim rebilling, and posting error by the Cashiering department. 04.2025 - 09.2025
Kohls, Inc.
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04/2012 – 2/2020
Billing Specialist – Commercial/Medicaid/Medicare
Work all identified insurance requirement edits through the Relay billing system.
Communicates issues with patient access and facility departments. Research required information and maintains pending follow up on a daily/weekly basis. This applies to all un-transmitted pending claims. Communicate daily information needed for billing to the Medicare Service Center via action notes and e-mail.
Daily works electronic insurance rejects in order to transmit with corrected insurance information.
Daily works re-bill submitted to the billing department through the electronic billing system.
Work all identified insurance requirement edits through the electronic billing system.
Daily work inventory submitted with the E-Request system. Process Medicaid/Medicare FL/GA/SC primary claims
Process Medicaid/Medicare secondary claims
06/2010 – 10/2011 HCA Shared Services
Underpayments Analyst
Perform second validation of discrepancy reason code assigned by the Discrepancy
Analyst.
Contact payer and initiate request for payment
Perform appropriate follow up with payer for payment as appropriate Escalate contract issues to the Supervisor
Practice and adhere to the ‘Code of Conduct’ philosophy and ‘Mission and Value statement’
Responsible for the Outpatient underpayment inventory for the underpaymen team.
03/07 – 01/2010 Precision Marine Concepts Inc.
Office Manager
Managed the company’s accounting
Resolution of accounts payable
Resolution of accounts receivables
Responsible for customer contracts agreements
Responsible for insurance credentials (i.e. workers comp., general liability, au Employee’s records (i.e. applications, insurance, etc) Maintain proposal and customer records
11/06 – 01/08 - Mayo Clinic
edical Coder – Physician
Responsible for entry of medical codes into system Responsible for the accuracy of entry
Apply appropriate code from written explanations
Validate data
01/04 – 03/07 - MacLeod Tile Contracting Inc.
Owner/Operation of family business
Tile Installations and bookkeeping.
12/01 - 12/03 5 Star Designs - Embroidery
Office Manager
Managed the company's accounting
Managed customer data
Maintain vendor data and inventory via QuickBooks
Correspond and set-up designs with customers
Maintain company inventory
Responsible for collections
Blue Cross and Blue Shield of Florida, Inc., Jacksonville FL 1984 – 2002
04/00 – 11/02 IT/ODS – Customer Relation Management (CIM) Functional Team Lead, Business
Perform continuous status tracking of open service request Recommend what process change initiatives should be pursued and how those changes should be carried out.
Provide input to SLAs, scope documents, proposals, etc. Proactively consult on large scale change initiatives. Oversee multi-departmental, complex projects and change initiatives. Provide design feedback on multiple components of a system. Monitor status of projects and work with others to address issues raised. Heavily involved in customer communications. Conduct post-implementation monitoring and evaluation. May provide customer support during initial rollout.
10/99 – 04/00 VO Business Consultant, Service Management Control Desk (VO Help Desk)
04/98 - 10/99 VO Business Consultant, Business Maintenance Serve as the primary point of contact for VO users to report problems and submit service request.
Perform the initial triage of service requests, document business requirements to support resolution of service requests, and submit service requests to the appropriate support organization for sizing. Determine the severity to be assigned to each service request & facilitate the resolution of the requests.
Communicate with users regarding service request status and hardware/software failures.
Perform continuous status tracking of open service requests, conduct daily monitoring of event logs, and respond to failures generated by the Event
Management initiator, Failure Queue, maintain OLAs with VO Service Provision and other IT support areas.
Conduct trend analysis for various VO Service Management functions Security Coordinator and Data Steward
Excellent coordination skills to effectively coordinate with various areas involved in diverse business effects.
Implementation of Business Maintenance releases
Support the expansion of VO capabilities and significant corporate initiates by providing business input and release leadership during the CIT/BIM lifecycle.
Complete process changes – creation of new workflows/procedures or revision to existing workflows/procedures.
Respond to problem tickets (PMF’s, failure queue records, email, etc.).
Complete Vendor Certification
Provide timely and accurate response to problem identification records received from Business partners.
Participate in the implementation of VO Release 1 Maintenance Release by providing release leadership and testing support during the execution of CIT, BIM and Production certification. 11/97 - 4/98 VO Business - Project Analyst
Build, Design and Create Release 2 Eligibility and Benefit requirements
Development of workflows, gap analysis and determination of process design solutions
Analysis and design of performance support
Development of test conditions, sceniors, and IVP’s. Provide support for the development of new business processes and applications
Assist in defining user requirements
1993 - 11/97 Operational/Contract Benefit Analyst III – National Accounts
Education 2006 U. S. Career Institute
Diploma in Medical Claims & Billing Specialist
ENVIRONMENT
TSO, IMS, CICS, MHS, MHS Security Coordinator Program, AAS User Support, Security Coordinator Program, DB2, Data Stewardship Program, Writer Scanner Facility (WSF2/ERD/EVT), SAS and COBOL 1, Artiva, Host,
Onbase, Empiric, Payor Facts, DET, Web tool, AutoWeb. WINDOW
APPLICATIONS
Microsoft Word, MS Excel, MS PowerPoint, ABC Flowchart, PMF, PI tracker, Test Plan Manager, VO Release 1 and VO Release 2.3.1. Memberships AHIMA member
North FL Boy Scout Event Coordinator
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