Medical Claims Analyst Resume Samples

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R Hauck

Rodolfo

Hauck

8506 Arlene Harbors

Dallas

+1 (555) 262 4165

8506 Arlene Harbors

Dallas

Phone

p +1 (555) 262 4165

Experience Experience

San Francisco, CA

Medical Claims Analyst

San Francisco, CA

Reilly and Sons

San Francisco, CA

Medical Claims Analyst

Ensure accurate entry of work into designated billing systems
Strong Knowledge of Excel
Ensure all insurance companies and governmental entities are posted accurately and in a timely manner using the correct forms, policies and procedures
Familiarity with ICD-10, HCPCS, CPT coding, HCFA 1500 & UB-04
Other Job related duties
Phone calls to insurance companies for follow-up
Demonstrate Company’s Core Competencies and values held within

Phoenix, AZ

Stop Loss Medical Claims Analyst

Phoenix, AZ

Zieme, Gusikowski and Green

Phoenix, AZ

Stop Loss Medical Claims Analyst

Establish cooperative and productive relationships with professional resources
Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records
Proficiency using the Microsoft Office suite of products
Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process
Demonstrated success in negotiation, persuasion, and solutions-based underwriting
An awareness of industry claim practices
Overall knowledge of health care industry

present

Los Angeles, CA

Medical Claims Analyst, Out of Network

Los Angeles, CA

Russel-Dooley

present

Los Angeles, CA

Medical Claims Analyst, Out of Network

present

Maintain reports within the department that will monetize more claims, improve quality, provide revenue opportunities and improve the management of workflow
Recommend system and operation changes to improve efficiency of workflow within the department
Research systems and data base for historical performance and outcomes to provide analytics
Review and approve outgoing and incoming correspondence to providers insuring complete accuracy for revenue impacted savings
Track the completion and outcome of individually assigned work within the team
Collaborate, coordinate, and communicate across disciplines and departments
Responsible for the review, maintenance and updates to existing agreements in the system

Education Education

Bachelor’s Degree

Michigan State University

Bachelor’s Degree

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3 Medical Claims Analyst resume templates

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Medical Claims Analyst Resume Examples & Samples

Ensure all insurance companies and governmental entities are posted accurately and in a timely manner using the correct forms, policies and procedures
Ensure accurate entry of work into designated billing systems
Review EOBs to ensure appropriate posting payment and the ability to resubmit claims to obtain correct payment
Obtain all necessary information from insurance companies as required for posting
Phone calls to insurance companies for follow-up
2 years experience in Medical Billing, medical posting or medical claims processing is preferred
Previous experience with electronic billing systems preferred

Stop Loss Medical Claims Analyst Resume Examples & Samples

Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions
Maintain claim block and meet departmental metrics
An awareness of industry claim practices
Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records
Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc
Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process
Establish cooperative and productive relationships with professional resources
LI-AE1
A minimum of five years experience processing first dollar medical claims
Demonstrated ability to work as part of a cohesive team
Significant knowledge of Stop Loss Underwriting and Stop Loss industry preferred, but not required
Demonstrated success in negotiation, persuasion, and solutions-based underwriting
Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
Overall knowledge of health care industry
Proficiency using the Microsoft Office suite of products

Medical Claims Analyst, Out of Network Resume Examples & Samples

Manage manual distribution of claims or workflow when system is unable to assign individually
Track the completion and outcome of individually assigned work within the team
Review and approve outgoing and incoming correspondence to providers insuring complete accuracy for revenue impacted savings
Research systems and data base for historical performance and outcomes to provide analytics
Maintain reports within the department that will monetize more claims, improve quality, provide revenue opportunities and improve the management of workflow
Responsible for the review, maintenance and updates to existing agreements in the system
Review and applying discounts as applicable to claims that fall out of the system automation as needed
Assist with special projects as assigned in conjunction with daily workload; prioritizing and shifting focus as needed
Back up to production teams as needed
Recommend system and operation changes to improve efficiency of workflow within the department
Collaborate, coordinate, and communicate across disciplines and departments
Ensure compliance with HIPAA regulations and requirements
Demonstrate Company’s Core Competencies and values held within
Minimum High School Diploma or GED
Minimum 2 years of experience in the healthcare setting such as negotiations, claims processing, customer service, worker's compensation or collection agency
Required licensures, professional certifications, and/or Board certifications as applicable
Strong to advance level of Microsoft Excel spreadsheets work experience
Knowledge of commonly used medical coding
Knowledge and understanding of negotiation process
Communication (written, verbal and listening), analytical, organizational, prioritization, technical, etiquette and interpersonal skills
Ability to use software and hardware peripherals related to job responsibilities including MS Office Suites with preferred profiency with Word, Excel, and other database software
Ability to be flexible in quickly shifting priorities and keeping up with changes across multiple tasks in a fast paced environment while maintaining a positive and cooperative demeanor
Ability to demonstrate strong technical skills
Ability to identify issues and escalate for course of action for resolution
Ability to elicit trust and credibility with all levels of the organization
Ability to adjust/alter schedule to meet deadlines
Ability to work independently and handle confidential information
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

Medical Claims Quality Analyst Resume Examples & Samples

Use pertinent data and facts to identify and solve a range of problems within area of experience
Understand and interpret explanations of benefits (EOB) data from variety of carriers in a variety of formats
Basic analysis and investigation of trends in the data and competitors product and rates
Retrieve and interpret claim reports to assist with efficient and accurate documentation of claims for delivery to internal and external customers
Research, identify and obtain data/information needed to help accurately interpret the data as needed
Provide feedback to co-workers through peer review process
Anticipate customer needs and contribute to proactive identification of solutions
Other duties as deemed appropriate to provide a quality, timely product for delivery to our customer
2+ years of medical claims adjudication and/or claim customer service experience with exposure to Coordination of Benefit (COB) and/or interpretation of Explanation of Benefits (EOB)
1+ years of data analysis (finding trends in data including plans, products and network rate differentials)
1+ years of MS Excel experience (formulas, sorting, filtering, formatting, V-lookups etc.)
Associate's degree
Ability to find trends in medical claim reimbursements and/or financial data sets
Experience with hospital/provider contracts
Medical coding/billing/CPT Codes
Knowledge of UNET/NDB, iDRS/EDSS and/or ppoONE