Revenue Analyst

Career Summary

Medical Billing / Accounting AR & AP / Collections / Healthcare Compliance/ Internal Audit/Revenue Cycle Management

• Highly organized, dependable and detail oriented - work well under pressure.

• 4 plus years of varied Medical Billing & Accounting - Compliance Analyst experience.

• Analyze and modify Medical billing and collections department procedures, implement profitable AR strategies.

• Accurate and efficient customer relations, with depth knowledge of AP & AR.

• In Depth knowledge of Medical office procedures - excellent computer skills and accurate keyboarding abilities

• Expertise in Dispute Resolution by working closely with the Operations Manager and the client to resolve difficult billing and svc related issues while utilizing effective negotiation tactics to the satisfaction of both the client as well as the company.

• Effective Multi-tasking - run billing department, set up new accounts in SIS, issue credits based on procedure issues.

• Conduct Bi-Wkly Review - of internal billing procedures to boost the collection of revenue.

• Enhance the Alignment of customer service and credit so that billing issues get quick resolved so that payment is expedited.

Professional Experience

Execute Search Firm (Harlem Hospital) New York, NY

Corporate Compliance Analyst October 2007 to Feb 2010

 Review and negotiate all payer contracts(Managed Care, CMS, Commercial)

 Review medical records for fraud, waste, and abuse.

 Supports the values of the organization by demonstrating personal responsibility, respect for self and others, innovation through teamwork, dedication to caring, and excellence in customer service.

 Conducts risk assessments to analyze the quality of medical record documentation related to ICD-9-CM and CPT/HCPC coding, applying physician and or facility reimbursement regulations and documentation guidelines to ensure accurate and complete coding.

 Responsible for managing accounts receivable and payment posting.

 Monitor bad debt and contractual losses.

 Reviews write-off listings, refund requests, miscellaneous cash adjustments, and departmental expense vouchers and submits to Director of Operations for approval.

 Review all remittance advice; determines significant problems causing rejections and denials.

 Served as a reference or source of information as need for the physician and accounts receivable area’s questions.

 Perform in-depth statistical analyses related to the Pay for Performance, particularly, meaningful use; ability to explain this analysis to a non-technical audience of both internal and external customers including management

 Ability to extract and define relevant information within patient or other revenue cycle data.

 Responsible for overseeing electronic submission of claims to Medicare, Blue Cross Blue Shield and Medicaid.

 Monitors compliance with policies and directives, Interpret and trend clinical and financial data. Take initiative to investigate variances and derive conclusions and solutions from this data.

 Communicates new procedures to other departments.

 Resolves patient, physician, and interdepartmental complaints and misunderstandings.

 Monthly reviews collection files and daily follow-up work.

 Oversees receipts for bank depositing and data entry.

Park Hudson International (Harlem Hospital) New York, NY

Revenue Compliance Analyst October 2005 to October 2007

 Handled a 5 member team involved in EOB payment posting, charge entry and Accounts receivables follow up and insurance verification

 Acts as resource for Compliance, accreditation, billing, credentialing, and other issues

 Successfully integrated inventory, charging software with billing system. Special Projects Manager involved in electronic patient file implementation, CDM Standardization, etc.

 Handled a team involved in EOB payment posting, charge entry and Accounts receivables follow up and insurance verification

 Was responsible for timely completion of charge entry and payment posting as per clients guidelines.

 Oversee both front end and back end staff.

 Training team on client feedback

 Review medical records for fraud, waste, and abuse.

 Ensure collections based on set targets and promised deliverables.

Children Healthcare of Atlanta Atlanta, GA

Surgical Services Business Analyst April 2003 to October 2005

 Monitor and oversee billing procedures, collection efforts and account receivables for Surgical Services.

 Act as liaison between Fiscal Department, Billing Services and the OR Unit.

 Audit charges and perform detailed analysis of the physician, patient demographics and charge entry.

 Facilitate the production of nurse charge charts, by generating all charges and follow-up account activities.

 Oversee insurance claim follow-up, recoding, verifications, and claim appeals to obtain payment resolution on claims.

 Support and maintain the Surgical Services and Anesthesia software applications, including scheduling (case & staff), preoperative, intra-operative, post-operative, supply and billing modules.

 Collaborates with the Operating Room Management Team to provide positive working relationships and delivery of accurate, timely, and effective services from the Central Sterile Processing Department

 • Manages Central Sterile Processing human resources to assure quality services, appropriate scheduling 24/7, and promotes positive employee relations.

Scotland Memorial Hospital Laurinburg, NC

Central Service Supply Supervisor May 2000 to April 2003

 Helped to facilitate clear communication between team members.

 Performed data-entry functions associated with secured information.

 Act in management role in absence of CSR Manager. Assist manager in quality control and overall management activities.

 Assess daily supply needs for the department and orders via Lawson system.

 Evaluates inventory and adjust via Lawson system to meet need of department.

 Oversee daily work assignment for Distribution Techs.

 Assist manager in the evaluation process of employees.

Nations Bank Greensboro, NC

Credit Collection Supervisor Oct 1997 to April 2000

 Initiate customer contact and evaluate customers' financial situations

 Negotiates for full payment or creates terms for repayment.

 Skip-trace to find and collect on delinquent accounts.

 Monitors and review work of Team Leads and their staff to ensure it is within Company, State and Federal guidelines.

North Carolina A&T State University August 1996- May 2000

B.A., Business Administration and Healthcare Administration

Technical Skills

Excel - PowerPoint - Publisher - Word - Oracle - Mas90 – Access-ADP SMS- SIS-Lawson- Siemens-Lotus Notes Crystal Reports - Peachtree –Quick Books- People Soft - Outlook Great Plains-CRT-Windows 20000-PowerPoint-SOX- Medicare FSS- Epic- Visio

Reference upon Request

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