Reimbursement Analyst Resume Samples

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Reimbursement Analysts work in medical facilities and determine patient reimbursement amounts. Essential job responsibilities of a Reimbursement Analyst are processing reimbursement requests, assisting patients, answering to inquiries, maintaining their knowledge of payer policies, analyzing data and documents, and maintaining records. A successful resume sample in the field should mention skills such as knowledge of reimbursement policies, customer service, strong numeracy abilities, effective communication, conflict resolution, recordkeeping, and computer competences. Business training is seen on most eligible resumes, but candidates holding just a high school diploma may also be accepted.

1

Senior Reimbursement Analyst

  • Audited incoming payments for over 200 emergency room and hospitalist clients across the country
  • Brought in $44,000 for an IL client by working with the state insurance agency and payer
  • Managed several high profile projects including a re-coding project with United Healthcare valued at approximately $1 million in charges
  • Sought out and fostered relationships with various payers and some state agencies, as well as researched low payments and resolved contract payment disputes
  • Resolved incorrectly discounted claims with third-party processing companies such as Multiplan and Stratose, receiving additional payments or settlements for well over $70,000
  • Built and maintained relationships with inter departments to resolve payment and contract issues
Candidate Info
6
years in
workforce
11
months
at this job
BA
History
MS
Healthcare Administration And Informatics
2

Reimbursement Analyst

  • Initiates appeals to third party carriers for erroneous reimbursement and analyzes contracts to find reimbursement discrepancies
  • Analyze inpatient and outpatient accounts for claim denial trends and utilizes lean methods to create processes to increase efficiency and decrease waste
  • Implemented new billing process that reduced 20% of aging AR
  • Specializes in reimbursement for Medicaid and Medicaid risk plans. Surpassed industry standard working more than 50 accounts a day
Candidate Info
8
years in
workforce
7
months
at this job
BS
Healthcare Management
MS
Healthcare Administration
3

Reimbursement Analyst/coder-philadelphia Liaison

  • Provided information on claims correspondence and assisted in the daily support and reimbursement of claims.
  • Worked and negotiated contracts for various acute and rehabilitation facilities to determine fees for products: Direct Access, Managed Care and PPO.
  • Supervised 11 staff members in the Administrative Office encompassing Accounts Payable/Receivables, and Collections.
  • Process facility and professional claims on the following forms (UB04, HCFA 1500, and UB92).
  • Utilizing Affinity Billing System, Medicare, Medicaid, and Medicare HMO claims and submit crossover claims as necessary.
  • Reviewed claims for (ICD-9, 10, CPT, HCPCS), units, and procedure codes also utilizing NPS Benefit coding.
Candidate Info
17
years in
workforce
12
years
at this job
BA
Human Resources Management
Anatomy & Physiology, Medical
4

Reimbursement Analyst

Analyze and process account receivable to ensure continuous cash flow and develop strategies while utilizing excel and payer projects.

  • Monitor National business accounts in excess of $60 million dollars yearly.
  • Communicate with management with any changes involving compliance, regulation and reimbursement issues
  • Develop effective strategies to enhance cash flow.
  • Develop and maintain relationships with other departments to streamline operation.
  • Develop detailed spreadsheets to identify trends and develop forecasts. Consolidate and analyze monthly results.
  • Research and document various issues.
  • Mentor and coach junior staff
  • Streamline cash flow $300,000 monthly
  • Streamline work flow which resulted in 20% decrease in errors yearly.
Candidate Info
10
years in
workforce
4
years
at this job
BBA
Business Administration
MA
Health Services Management
5

Reimbursement Analyst

  • Serve as a liaison between departments (Psychiatry, CIDD, TEACCH and Emergency Medicine) and Revenue Cycle Analytics.
  • Work closely with clinic managers, staff and physicians to review denials, physician's notes and aged claims to improve reimbursement by insurance payors.
  • Facilitate weekly meeting to present Key Metrics to leadership within the healthcare.
  • Analyze denials from insurance payors to identify trends and determine root cause of denial.
  • Utilize Business Objects to create reports to fulfill internal and externals ad-hoc requests, as well as maintaining ongoing scheduled reports.
  • Draft system edits and logic for Epic to ensure claims are routed to the work queues.
Candidate Info
6
years in
workforce
2
years
at this job
BS
Business Administration And Law
6

Reimbursement Analyst

Reviews patient data to prepare current year bad debt listings while making sure the facilities recognize their full reimbursement potential.

  • Exchanges data with clients and third-party data sources, such as vendors, Medicare, Medicaid, etc.
  • Troubleshoots situations where data does not meet established thresholds and standards.
  • Maintains strong knowledge of all HPS products and services.
  • Reviews prior year patient data to identify missed reimbursement opportunities for bad debts and disproportionate share.
Candidate Info
11
years in
workforce
2
years
at this job
BS
Accounting
7

Reimbursement Analyst

  • Investigate underpayments on pharmacy prescription AAC and NADAC Medicaid CMS claims
  • Analyze acquisition cost data and market pricing to arrange rate increase proposals independently
  • Quality inspector of managed care claims to verify accuracy after data entry before final review
  • Develop employee training guides and tracking logs for new review processes in Excel and Access
  • Create monthly marketing reports and cross-check rate updates and analysis data via SQL
Candidate Info
17
years in
workforce
2
years
at this job
HS
High School Diploma
AAS
Accounting, Bookkeeper And Payroll Certificates
Interior Design
8

Reimbursement Analyst

  • Creating and Uploading Fee Schedules and Contracts to our Billing Software (Epic)
  • Calculating reimbursements received from the Payor
  • Maintaining spreadsheets with Payor Issues
  • Working with Payors on payment issues to get them resolved in a timely manner
  • Building and maintaining Payor and Plan contracts within Epic
Candidate Info
12
years in
workforce
2
years
at this job
HS
High School Diploma
C
Medical Insurance Specialist
AS
Associate of Science
9

Reimbursement Analyst (contract)

  • Collected and reviewed all patient insurance benefit information
  • Maintained frequent phone contact with provider representatives, third party
  • Customer service representative, pharmacy staff, and case managers
  • Re-verify patients coverage and benefits
  • Provided stellar customer service to internal and external customers
Candidate Info
6
years in
workforce
4
months
at this job
10

Reimbursement Analyst

  • Manage Accounts Receivable to ensure timely and maximum reimbursement
  • Appropriately appeal insurance claims in a timely manner
  • Research and write up refunds
  • Review dictation and operative reports adding or correcting diagnosis codes when needed to get claims processed and paid, appealing unpaid charges when necessary
  • Correct adjustments and move money between accounts to correct billing errors when needed
  • Participate in team meetings to manage and plan the best patient care
  • Provide the customer service possible by developing and maintaining an effective and efficient relationships with the patient
  • Routinely prepare reports and present data to organizational level management
Candidate Info
12
years in
workforce
7
months
at this job
HS
High School Diploma
C
Certified Life And Health Insurance Specialist

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