For the given job description <<Job SummaryWe are looking for a Business Analyst for our team. This candidate requires experience within a Health Insurance company.
This candidate must have experience working in a billing environment and must have excellent communication and writing skills with the ability to work with people at all levels of the organization.
Personality traits necessary to be effective with the team:Looking for a Business Systems Analyst that is very confident and can handle an executive-level audience. The best candidate will be outgoing, confident, and have excellent communication skills as they will work with all audience levels. 
Required ExperienceSDLC Knowledge Experience Creating Waterfall Requirements Agile Scrum Visio Traceability Business Experience Creating Documentation Develop Requirements Artifact Management MS Office Suite Creating Process FlowsFacilitation Communication>> the resume: <<Professional BackgroundCertified Coding Specialists (CCS) with E/M, outpatient, in patient/ER admits, diagnostic, procedural /pro fee Coding, CMS-DRG, VBP, CPT II codes, HEDIS, HCC, RAF, data analyst and quality auditing in health management programs, ICD 10 Certified.  5 Years experience in Administration/ Office management and as Coding/billing manager.  Licensed EMT-I since 2002.  10+ years' experience in billing and 6 years coding experience, 3rd Party insurance follow up which include commercial, work comp, VA, Medicare, Medicaid, appeals, insurance verification, authorizations. 5+ years Clinical as a Medical Assistant, phone triage, in office surgical procedures.   I have a total of 18 years working in the medical field and VERY customer service oriented. Knowledgeable with various different EMR, EHR systems, Cerner, Centricity, Athena, Allmeds to name a few. Excel, Word, Outlook,Salesforce. I have two secret Government clearances given 1985 still active thru the Department of Defense so all my background checks run smoothly and pass with flying colors.
Skill HighlightsCCSAttestationsSDSHEDIS/Quality measuresHCCCMS-DRGOut patinetSkilled nursingHome healthRAFVBPCPT II codesICD- 10EPRGSales forceWordExcelOutlook10 Key by touch62 WMP typingEpicPulseencoderCernerAllmedsEMR/EHR
Education and TrainingEdison Community college,Expected in2002––Allied Health Business college ICD 10, Certified Coding Specialists
Current: NAHP, AHIMA & AAPC memberships.:Emergency Medical Services-GPA:Emergency Medical Services
Professional ExperienceAltium-CMS / HHCS/ HEDIS/Coding/ data analyst and quality coordinatorLa Jolla,CA,06/2016-CurrentReview, obtain data extracted remotely and on site physician medical records to analyze quality and outcome of health management programs, quality, pharmacy, Financial, claims, coding, helping to locate where providers need to close gaps, information missing to maintain highest ratings and help with SDS/attestation submission. Knowledgeable with many different EMR systems, HHCS, RAF, HEDIS, CMS DRG CPT II, Coding guidelines. Our goal is to see that the physician receives any and all monies available to them and to help them provide the best possible healthcare to our members. We provide training to the offices where they may need help in closing these gapsDr MT Pally MD Cardiologist-Coder/Billing ManagerCity,STATE,04/2015-2016Performed daily charge entry, review and obtained codes using MS-DRG, VBP, HCC, RAF, HEDIS quality auditing/guidelines, Coding for all office visit, inpatient hospital visits, tests, ER admits, Echo's/Vascular, Nuclear stress Testing, PET Scan and all nursing home, home health visits. Query physician and tech for any missing or incomplete documentation, maintaining a high productivity standard with 95%+ accuracy, working denials, letters of appeals. Assisting the front desk whenever needed, answering phones, scheduling appointments, verifying insurance's, obtaining authorizations.  Ali XXX XXX 9550Tenet Health Catawba Cariothoracic Surgeons-Coder/Front Office Coordinator/coderCity,STATE,08/2014-03/2015Check in/check out, scheduling, phone triage, insurance verification, insurance authorizations, Medical assisting, room patients, obtain vitals, chart documentation, Reviewed and code entry using MS-DRG, VBP, HCC, RAF, HEDIS quality/guidelines, answering high volume calls, data entry in Nex Gen *EMR, managing medical records, surgical boarding, collecting copays, deposits and provide quality customer service.800 367 2884 Ann Marie.HMA/Physicans Regional Hosptial-Coder/Insurance verification specialistsCity,STATE,07/2013-08/2014Reviewed and corrected Coding using the MS-DRG, VBP, HEDIS quality auditing/ guidelines for all the high cost surgical procedures, verified and authorized insurance, quote patient pricing, answer any patient questions regarding insurance, pricing or procedure, data entry in EMR system, team player and provide excellent customer service. Stacy 704-660-4584.Centura Health Systems-Coder/Patient Account RepresentativeCity,STATE,07/2010-01/2013Answered high volume patient's questions, insurance verification, data entry in Meditech, work insurance collections, 3rd party follow up, query physicians and tech for missing or clarification of documentation, corrected coding issues, performed paper and electronic billing, correct ICD-9 CPT coding using MS-DRG, VBP, HCC, RAF, HEDIS quality auditing/guidelines for accounts receivables, and provide excellent customer service.Was a rehire Tawyna Scott XXX-715 7000.The Swedish Hospital-Medical Assistant/EMT at Hand Surgery Associates atCity,STATE,09/2009-05/2010Triage and room patients, provided assessment of injury/wounds, removed sutures, dressings, applied casts and splints, assisted with surgical procedures, and performed data entry in EMR and provide excellent customer service.Kim Beard XXX 744 7078.Associates Of Otolaryngology-Medical Assistant/EMT at Associates of OtolaryngologyCity,STATE,04/2008-06/2009High volume phone triage, greet and room patients, obtained vitals, performed data entry in EMR system, in room scribe, assisted with office surgical procedures, ICD-9, CPT coding, transcription, injections, biopsies, cultures, lab and radiology orders, Team player and performed excellent customer service.Diana Mcleron XXX 744 1961Press O Matic Keyless Locks-Office ManagerCity,STATE,2005-2008Manage front office, answered phones, assist with phone sales and walk in sales, invoicing, shipping and receiving, A/R, A/P, quick books, handled monthly inventory, ordering, restocking, some assembly of production line when needed, faxed, filed, copier, 10 key by touch, 62 WPM typing, some soft collections. Outlook, Excel, Word.  Dave Campbell  XXX 762 7373.Lee Health-Out patient registration/Central SchedulingCity,STATE,10/2001-01/2005Handled large volume of patient calls scheduling patients for all out patient testing, obtaining correct dr orders with correct coding.  Obtained and data entry correct patient demographics insurance information at time of out patient testing, verified insurance information, collected co payments, assisted patients to areas of testing.  provide excellent customer service.21st Century Oncology-Biller/customer service/payment posterCity,STATE,10/1998-10/2001Posted large insurance checks and patient payments to correct DOS in accounts, balance daily, answered patient questions regarding billing/accounts, worked 3rd party denials, timely filing, letters of appeals for Medicare, Medicaid, VA, work comp, commercial insurances, corrected coding errors. worked with patients on payment agreements and soft collections, met daily productivity goals, provided excellent customer service.
Skills10 key by touch, accounts receivables, RAF, Anatomy, AP, scheduling appointments, AR, auditing, billing, Bookkeeping, Call center, Cardiologist, closing, CMS, CPT II, CPT coding, CPT, excellent customer service, customer service, data analyst, data analysis, data entry, documentation, faxing, filing, Financial, Front Office, home health, ICD 10, ICD-9, injections, Insurance, inventory, invoicing, letters, Director, managing 5, managing, Medical assisting, Medical Manager, Medical Terminology, Meditech, meetings, Excel, Office, Outlook, Word, Nursing, nursing home, ordering office supplies, outside sales, payment processing, pharmacology, Physiology, pricing, processes, Coding, Quality, quick, Quickbooks, radiology, sales, Scheduling, shipping, spread sheet, Supervisor, Surgery, Team player, answering phones, phones, phone, transcription, Triage, phone triage, typing, wound care.>>. The result is, No Fit

Fit assessment: No Fit