Category: HEALTHCARE

         HEALTH SYSTEMS ANALYST       Summary    Healthcare-Business professional with experience in competitive component resolution that drives revenue, growth, profits, and operational performance. I am seeking an opportunity with an organization that offers a visionary, innovative and professional environment that defines my experiences to rapidly understand new technologies and gain new skill sets. Self-motivated, detail oriented and adept communicator with solid written and verbal communication skills. Loyal, dedication and ambitious employee. Willing to travel or relocate.      Education and Training     2016     University of Saint Francis   City  ,   State         Master of Health Administration           2010     Pfeiffer University   City  ,   State      Business Administration and Management Information Systems   Bachelor of Science Degree    Business Administration and Management Information Systems       2012        Certified Health Information Technology -Implementation Manager Certification-CHTS-IM            Skills          Proven patience and self-discipline  Conflict resolution  Relationship and team building     Claims analysis and review specialist        Critical thinking proficiency  Government relations knowledge  Proven patience and self-discipline  Motivation techniques specialist            Activities and Honors    American Health Information Management Association, Member, AHIMA 2012-Present
Dress for Success 2010 to Present      Experience     January 2017       Company Name    City  ,   State    Health Systems Analyst        Hands-on configuration and troubleshooting in claim in real-time environment as they relate to Resolute.  Knowledge of rules, work queues, billing indicators, statement processing, letters, self-pay follow-up with payment/ adjustments and reporting.  Extensive experience in patient accounting, billing, managed care, claims and decision support.  A solid understanding of business aspects of healthcare operations and workflow.         January 2017   to   May 2017     Company Name    City  ,   State    Health Systems Analyst        Hands-on configuration and troubleshooting in claim in real-time environment as they relate to Resolute.  Knowledge of rules, work queues, billing indicators, statement processing, letters, self-pay follow-up with payment/ adjustments and reporting.  Extensive experience in patient accounting, billing, managed care, claims and decision support.  A solid understanding of business aspects of healthcare operations and workflow.         January 2007   to   January 2014     Company Name    City  ,   State    Healthcare Claims Analyst        Loaded and analyzed Medicaid, Medicare, and Commercial health plan data.  Implemented analytic directives from senior staff and clients.  Investigated issues in healthcare data from acquisition through presentation.  Contributed to the development and maintenance of operational, financial, and performance-related reporting packages.  Generated Medical reports summarizing cost and utilization trends and investigate drivers.  Developed reports for clients using our business intelligence tool.         January 1996   to   January 2007     Company Name    City  ,   State    Senior Benefit Claims Consultant        Supervised (25) employees to improved efficiency, increase production, implement workflow processes, optimize  Lean efficiency and training procedures for managed care and auto adjudicated claims.  Achieved operating-margin targets while fostering a culture of performance and continuous improvement.  Gained increase of 25% in financial raises and stock options.  Work relationship with Executive, Directors, and clients to maintain good communication goals.  Ensured contractual compliance requirements and reporting.  Streamlined daily operations of departments, analyzed internal practices, identified areas of opportunity, presented problem solutions and generated efficiency recommendations.  Reimburse expertise on products in all place of service under medical, pharmacy and vision.  Experience in contracting Hospital and Physician.  Researched and Analyzed Insurance Data as directed.  Maintained 95% production and performance goals for six consecutive years.  Experience of coding systems with electronic claims and Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases(ICD-9).         July 2011   to   April 2016     Company Name    City  ,   State    Academic Resource Specialist II       Maintained detailed administrative and procedural processes to improve accuracy and efficiency.    assignment duties such as implementation of performance programs, and lesson assessment programs.  Developed and executed strategic and tactical plans to meet student and organization needs.  Interacted and Partnered with  staff and key management teams in implementing strategic action plans to help with  identifying organization objectives.  Effectively increase retention efforts by 75% through the adoption of the early-alert program through computer software Starfish Application.          Skills    Accounting, billing, business intelligence, CMS, continuous improvement, contracts, CPT, Critical thinking, clients, Customer Support, Data Analysis, decision support, drivers, Financial, Health Information Technology, ICD-9, Insurance, letters, Microsoft Office, pricing, processes, Coding, Project Management, Quality, Quality Assurance, real-time, reporting, strategic, troubleshooting, Vendor Management, vision, workflow