Full-time Epic Certified Consultant in the Business Intelligence, Data Analysis, and Reporting space.

-Analyze claims data to identify contractual underpayments, denials, and/or billing errors as well as identify trends-Review claims for inappropriate or potential corrected coding to increase client revenue-Review medical records and clinical data in compliance with HIPAA guidelines to determine whether contract analysts can appeal claims-Identify ways to improve departmental efficiency, automate processes and increase productivity-Establish and maintain effective communications with the hospital clients and payers -Support Recovery Analysts as a resource for account variance clarifications-Closely monitor the daily, weekly and monthly progress towards revenue and submissions goals and objectives and aid the teams in achieving those goals-Successfully utilize PMMC’s contract management software as well Microsoft programs such as Excel, Access and SQL-Generate activity reports for the department and clients-Quickly gain familiarity with various HIS/EMR systems including EPIC, Cerner, Paragon, Meditech, Affinity and others as new clients are onboarded

-Analyzed claims data to determine if contractual variances existed-Maintained a successful pipeline well exceeding all departmental collection and revenue goals-Professionally interacted with insurance providers and clients to resolve underpaid claim discrepancies -Assisted in onboarding new contract analysts

-Identified, analyzed and recovered overpaid healthcare accounts on behalf of Blue Cross plans, commercial insurers and state Medical Assistance programs-Introduced and promoted custom analysis software designed by CDR Associates, LLC -Communicated with various hospital personnel to effectively explain the audit process, conveyed results in a succinct and timely manner and followed with clients to resolve any discrepancies-Gained proficiency in various commercial insurance payment processes and rates as well as a variety of patient accounting systems in a short period of time-Functioned well independently as work was completed 50% from home, 50% while traveling to on-site audit locations

-Analyzed completed audits and reports of exposure for accuracy and adequacy-Calculated final net premium adjustments in accordance with insurance manuals and procedures-Resolved discrepancies on audit adjustments by consulting with auditors, agents, underwriters and insureds

Responsible for proving, reconciling, and investigating discrepancies for the Grand Cayman branch and International Banking Facility’s general ledger accounts.