- Featured in:
-
High Quality
The best examples from thousands of real-world resumes
Expert Approved
Handpicked by resume experts based on rigorous standards
Diverse Examples
Tailored for various backgrounds and experience levels
Reimbursement Analyst Resume Samples
Filter:
No results found
Candidate Info
6
years in workforce
11
months at this job
BA
History
MS
Healthcare Administration And Informatics
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
8
years in workforce
7
months at this job
BS
Healthcare Management
MS
Healthcare Administration
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
17
years in workforce
12
years at this job
BA
Human Resources Management
Anatomy & Physiology, Medical
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
10
years in workforce
4
years at this job
BBA
Business Administration
MA
Health Services Management
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
6
years in workforce
2
years at this job
BS
Business Administration And Law
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
11
years in workforce
2
years at this job
BS
Accounting
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
17
years in workforce
2
years at this job
HS
High School Diploma
AAS
Accounting, Bookkeeper And Payroll Certificates
Interior Design
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
12
years in workforce
2
years at this job
HS
High School Diploma
C
Medical Insurance Specialist
AS
Associate of Science
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
6
years in workforce
4
months at this job
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
12
years in workforce
7
months at this job
HS
High School Diploma
C
Certified Life And Health Insurance Specialist
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
16
years in workforce
15
years at this job
BS
Business Administration
MA
Management
MA
Social Work
Reimbursement Analyst
- Prepared annual Medicare and Medicaid cost reports.
- Prepared monthly hospital cost reports as assigned.
- Assisted in the creation and development of training manuals.
- Coordinate internal/external audits.
- Book monthly accruals and settlements.
- Conducted analysis of financial statements and associated risks.
- Interpret state and federal regulations regarding cost reporting.
- Evaluate profit and loss statements and compliance to budget.
- Participate in special projects and perform other tasks as assigned.
Candidate Info
12
years in workforce
1
year at this job
BA
Business Administration
Reimbursement Analyst
- Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly. Reports any reimbursement delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.)
- Analyzes collection reports, identifying opportunities for work process improvements with respect to claims denials. Works cross teams on strategies to improve front end related issues. Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
- Coordinates with inter-departmental associates to obtain appropriate information as they relate to the reimbursement process. Maintains confidentiality in regards to patient account status and the financial affairs of pharmacy/corporation. Communicates effectively to payors to ensure accurate and timely electronically filed claims. Typically receives little instruction on day-to-day work, general instructions on new assignments. Performs related duties as assigned.
Candidate Info
5
years in workforce
5
years at this job
HS
High School Diploma
AA
Associate of Arts
BS
Business
Reimbursement Analyst
- Assist management in developing policies, procedures, reports and other tools to improve work productively
- Revise and update benefit plan documents; draft clear and concise written correspondence of guidelines, health education, operational manuals, or instructions for dissemination: Standard Operating Procedures (SOPs) and Desk Top Procedures, memos, fact sheets, program briefings, questions and answers, and program summaries
- Prepare health care data reports; prepare presentation materials for meeting, briefing with senior management and/or other personnel to inform them of trends and requirements; translate complicated data into useable information
Candidate Info
21
years in workforce
2
years at this job
BA
Political Science
MBA
Management
Warranty Reimbursement Analyst - Contractor
- Review and evaluation of labor and parts reimbursement from dealer network.
- Comprehensively analyze and evaluate each request in its entirety then present final outcome of review to Warranty Information Intelligence
- Compile data and create monthly executive Aftersales reports for management.
- Compile data and create monthly labor and parts reports.
- Find, compile and process data to be presented to project lead.
- Interact with field personnel, legal department, and other business partners regarding matters pertaining to specific parts and labor topics.
- Review and update legal requirements of each state for Warranty related laws.
- Perform analyses using Hyperion and COGNOS.
Candidate Info
24
years in workforce
11
years at this job
AA
Business
BS
Accounting And Business Administration
Senior Reimbursement Analyst
- Calculate hospital/physician month-end contractual allowances
- Prepare monthly analysis of hospital/physician net patient revenue and bad debt expense
- Coordinate & prepare work papers for audit of Medicare/Medicaid cost reports
- Field reimbursement inquiries from Patient Financial Services and department managers
- Maintain the Contract Maintenance Module for Epic for Medicare and Medicaid
- Collaborate on Medicare/Medicaid rate changes with Patient Financial Services, Information
- Prepare hospital/physician budget on contractual allowances and bad debt expense
- Coordinate Medicare Wage Index and Occupational Mix Surveys
- Research and report impact of Medicare reimbursement issues
- Supervise duties of the Reimbursement Assistant
More Reimbursement Analyst
Resumes
Reimbursement Analyst Resume Success Stories
