Experience

The University of Toledo College of Medicine and Life Sciences

• United States
• Higher Education
• 200 - 300 Employee

• Contract/Reimbursement Analyst

  • Dec 2017 - Present

  • Identify underpayment opportunities to increase cash collections.• Identify trends relating to denials per payer.• Liaison for UTMC and insurance provider representatives, i.e. Paramount, Buckeye, Aetna, Anthem, Aetna Better Health, Caresource, Medical Mutual, United Healthcare • Full knowledge of drug administration hierarchy and charging guidelines• Conducts and interacts with multiple UTMC departments, third party payers and vendors to resolve variance or system issues.• Files complaints with the state regarding non-compliant payers.• Prepares accurate reports and analyses of contract management reimbursement performance activity.• Works with chargemaster and managed care teams to monitor reimbursement according to contracts.• Prepare accurate reports and analysis including financial reports, contract management, performance metrics, adverse trends and appropriate recommendations or conclusions.• Communicate with multiple personnel, networks and Third Party Administrators in resolving variances.• Conversion of accounts to inpatient/observation as required by Utilization Management and/or insurance payers.• Prepares and submits payer disputes regarding reimbursement* Knowledge of ICD-9 and ICD-10 coding, billing and collections and Managed Care contract language* Proficient in Allscripts, McKesson, Epic, Excel, Microsoft Word, Pcon contract managment



ProMedica

• Brazil
• Business Consulting and Services
• 1 - 100 Employee

• Sr.Patient Account Analyst/Observation-Audit

  • Apr 2004 - Dec 2017

  Charge entry for observation hours, medications including, infusions, chemo drugs, Ivp's and injections. Converting accounts from inpatient to observation and all facility charges that were accrued during observation stay. Keeping all observation reports for 7 hospitals, current. Reviewing accounts to validate whether observation or inpatient is appropriate and if so, if there is a valid authorization on file. Knowledge of Medicare guidelines and rules are also a must in my position. Charge entry for observation hours, medications including, infusions, chemo drugs, Ivp's and injections. Converting accounts from inpatient to observation and all facility charges that were accrued during observation stay. Keeping all observation reports for 7 hospitals, current. Reviewing accounts to validate whether observation or inpatient is appropriate and if so, if there is a valid authorization on file. Knowledge of Medicare guidelines and rules are also a must in my position.