Senior Analyst
CurrentSkilled coding, pricing and issuing payments for Inpatient, Outpatient, Medicare A, B, and D, Peehip (State), FEP (Federal) and Drug claimsSkilled in reviewing and processing medical Explanation of Benefits and Medical Records requestIdentified medical conditions and classifications for billing purposesWorked with an inpatient and outpatient revenue cyclePresented presentations to multiple employees from different departmentsExperience coding medical claims using CPT codes, HCPCS codes and ICD 9/10 Diagnosis for accurate billing and payments Coordinated member benefits with other insurance companies to ensure primary, secondary and tertiary payments are issued in a timely fashion per company guidelinesCompleted open enrollment with groups to ensure applications, questions and all information is completed properly before system implementationUpdated health, dental and vision benefits for members, employees, small groups and retireesExperience working on special projects assigned from different managers throughout the organizationAssisted in open enrollment initiatives such as company planned events, and onsite projectsConducted reviews of medical records to ensure compliance with coding and documentation per government requirementsExperience applying appropriate modifiers to claims for accurate payments Works productively and effectively under conditions of high stress, such as tight deadlines, heavy workloads, or emergency situationsHas working knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, JIVA, designing forms, and other office procedures and terminologyTrained groups of employees on newly developed claim processes in order to improve productivity and group retention.
