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Reimbursement Systems Analyst at Home Medical Equipment Specialists LLC
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Competencies
Expertise in medical billing, claims review, coding accuracy, and reimbursement processes.
Skilled in creating and reviewing reports to monitor pricing, inventory, and financial metrics.
Proficient in maintaining inventory pricing and fee schedules across multiple insurance providers.
Effective in managing client interactions, resolving billing issues, and ensuring compliance.
Education
Summary
Dedicated analyst with over 5 years of experience in billing, reimbursement, and data reporting within healthcare and medical equipment sectors. Proven ability to optimize processes, ensure accuracy, and improve revenue cycles.
Key Achievements
- Maintained accurate inventory pricing across multiple insurance fee schedules, enhancing billing accuracy.
- Developed and optimized sales order validation rules, reducing processing errors.
- Reviewed and reworked medical invoices to ensure proper coding and reimbursement, improving revenue flow.
- Created comprehensive reports linked to item pricing, supporting strategic decision-making.
Experience
Reimbursement Systems Analyst
Upkeep of inventory pricing over several insurance companies fee schedules, Creation and upkeep of sales order validation rules and logic, Creation and review of various reports linked to item pricing
Reimbursement Specialist
Reviewal of medical billing claims to ensure company is properly reimbursed, Reviewing rental equipment for pickup, Re-working invoices for proper medical coding, Ensuring COB is properly applied, Contacting insurance companies for member eligibility, authorization and claims information
Clinical Review Specialist
Keying of information (member, drug, dosage and provider) for prescription medication services
Claims Adjuster Specialist
Reviewing previously incorrectly processed medical claims for inconsistencies and payment inaccuracies, Reviewing member information, medical procedures, pricing, provider information and medical coding for Medicare, Medicaid and Commercial service claims to HIPPA guidelines
New Day Claims Processor
Reviewing initial claims for member information, medical procedures, pricing, provider information and medical coding for Medicare, Medicaid and Commercial service claims to HIPPA guidelines
Member Service Specialist (low level manager)
Front end/Back end manager in charge of watching registers, End of day till counting, Product location and acquiring and management/paper work for a time of 15 employees
Maintenance / Janitorial
Sanitization and maintenance of a multi-product Wearhouse
Maintenance / Janitorial
Sanitization and maintenance of a major department store
Pastry Chef / Shift Manager / Lead Pastry Chef
Baker of fine pastries, artisanal breads, high-end deserts, catered desserts and chocolatier
Chef
Preparation and cooking of multiple styles of cuisine including both plated, high-end foods as well a buffet and catered event meals
Grill Cook
Preparer and server of fast and convenient food
Dishwasher/Janitorial
Sanitization of food service equipment, utensils and service ware
Customer Service Manager/Representative
Shift manager of several employees for closing shift