Recovery / Resolutions Analyst Resume Sample
Jay Bauch
93589 Bradtke Forest,
Houston,
TX
+1 (555) 737 2860
Work Experience
Senior Recovery / Resolutions Analyst
10/2017
-
PRESENT
Phoenix, AZ
- Investigate and process recoveries and account payables on subrogation claims and workers’ compensation file management
- Working with claims and/or recoveryAnalyzes and investigates
- Audit Stop Loss Claims to ensure payments are processed appropriately by the administrator of the plan
- Review Employer Plan Documents pertaining to medical benefits and eligibility to ensure all claim payments made by the administrator of the plan are reimbursable under the Excess Loss Policy. This would include reviewing
- Performs clinical coverage review of post-service claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
- Clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review
- Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
- Performs clinical coverage review of post - service, pre - payment claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
Recovery / Resolutions Analyst
04/2010
-
04/2017
Dallas, TX
- Conduct member / provider telephonic interviews
- Collaborate with clinical, and / or legal on case strategies
- Review Monthly Add / Delete Reports
- Handle incoming / outgoing calls, faxes and mail from healthcare providers
- Monitor and manage call and review case load, ensuring expedient review resolution
- Compile documentation and review for accuracy and completeness
- Data entry for all calls, documentation, and review outcomes
- Participate in all meetings and training sessions
Recovery / Resolutions Analyst Telecommute
05/2005
-
11/2009
Phoenix, AZ
- Attend onsite reviews
- Attend and / or participates in hearings
- Actively identifies and shares best practices
- Review provider disputes, summarize specifics of review results
- Perform investigation on tips / allegations to identify potential Fraud, Waste, Abuse, or Error (i.e. internet research, review claims history on various platforms and FWAE databases), based on applicable Job Aids
- Investigate and identify over - payments on all claims types, as well as assist in recovery and resolution for health plans, commercial customers, and government entities as needed
- Lead projects to improve processes
- Table maintenance to ensure letter output is accurate
Education
Everest University - Clearwater Campus
2000 - 2004
Bachelor's Degree in Healthcare
Professional Skills
- Advanced communication (verbal and written) and analytical skills
- Utilize MS Word, Excel, and Outlook (typing, word processing, presentation, and spreadsheet application skills)
- Work experience using MS Excel – editing, filtering, sorting, creating spreadsheets
- Experience with Microsoft Excel including data entry, sorting, creating / modifying spreadsheets
- Insurance Experience with one or more of the following: Claim Processing, Provider Demographic Information or Insurance Billing Practices
- Intermediate level of Microsoft Excel experience using pivot tables, sorting, and filtering
- Current CPT / HCPCS coding experience (entering codes, auditing etc.)
How to write Recovery / Resolutions Analyst Resume
Recovery / Resolutions Analyst role is responsible for government, insurance, research, compensation, auditing, database, training, software, health, outlook.
To write great resume for recovery / resolutions analyst job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Recovery / Resolutions Analyst Resume
The section contact information is important in your recovery / resolutions analyst resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Recovery / Resolutions Analyst Resume
The section work experience is an essential part of your recovery / resolutions analyst resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous recovery / resolutions analyst responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular recovery / resolutions analyst position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Recovery / Resolutions Analyst resume experience can include:
- Effectively communicate to internal and external clients
- Experience auditing and monitoring cases
- Medical claims coding / medical terminology / processing experience
- Experience working in an office setting environment in the healthcare insurance industry
- Experience in developing and preparing written process documentation
- Experience in MS Word and Excel - creating / saving documents and spreadsheets, formulas, pivot tables
Education on a Recovery / Resolutions Analyst Resume
Make sure to make education a priority on your recovery / resolutions analyst resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your recovery / resolutions analyst experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Recovery / Resolutions Analyst Resume
When listing skills on your recovery / resolutions analyst resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical recovery / resolutions analyst skills:
- Experience using Excel Creating and maintaining spreadsheets
- Work experience using MS Word – editing & creating documents
- Work experience using MS Word – creating, editing documents
- Previous experience in claim processing, healthcare provider information and healthcare billing practice
- Medical claims coding & processing experience
- Experience in understanding and applying Centers for Medicare and Medicaid Policies and Regulations
List of Typical Experience For a Recovery / Resolutions Analyst Resume
1
Experience For Senior Recovery / Resolutions Analyst Resume
- Demonstrates a depth and breadth of knowledge / skills in own area and is often able to apply these outside of own function
- Experience with Microsoft Outlook (create and send emails, be able to use the calendar) and Microsoft Word (create and edit documents)
- Experience with Microsoft Access ( ability to maneuver through all aspects of this application)
- Health insurance claims experience
- Experience in Optum Waste and Error Policies and Procedures
- Attend occasional onsite reviews
- Investigate and identify over-payments on all claims types, as well as assist in recovery and resolution for health plans, commercial customers, and government entities as needed
- Investigation, recovery and resolution of all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
2
Experience For Senior Recovery Resolutions Analyst Resume
- Initiate phone calls to members, providers and other insurance companies to gather coordination of benefits
- Research and perform data analysis to identify potentially aberrant providers
- Research client payment policies
- Request detailed report data
- Serve as liaison between client and PIRT team for Provider education referrals
- Research provider tip referrals submitted by internal/external parties
- Development of Client Presentation Decks
- Management of SharePoint and Shared Drive Files
- Production related activities – 40%
3
Experience For Recovery Resolutions Analyst Resume
- Analyze data and claim information
- Contribute to and/or lead team huddles and meetings
- Provide timely follow up communication with internal and external clients
- Serve as a backup to the team supervisor when necessary
- Analyze documentation submitted, review provider disputes, and summarize specifics of review results for Hospital / Professional claim types
4
Experience For Recovery / Resolutions Analyst Telecommute Resume
- Attend and participate dispute/ administrative hearings
- Analyze data and interpret legal research to make conclusions
- Utilize your understanding of and expertise of coverage, policy interpretation, contract interpretation, case law, state / federal regulations Identify, monitor and evaluate data to determine third party liability and reimbursement amounts; ongoing analysis of medical treatment to evaluate relatedness
- Conduct a high volume of outbound calls and expeditiously send out or respond to electronic, written and verbal inquiries to / from attorneys, insurance companies and health plan members
- Validate claim liability, adjuster's contact information, claim status, availability of coverage, accident - related injuries and health plan members' treatment status
- Communicate effectively with various parties using all forms of correspondence throughout the subrogation recovery process
- Successfully maintain multi - million - dollar portfolio up to $50M
- Solves complex problems on own, proactively identifies new solutions to problems
5
Experience For Senior Recovery & Resolutions Analyst Resume
- Acts as a facilitator to resolve conflicts on team, seen as key team member on project teams spanning more than own function, works the aged provider overpayment inventory to secure recovery or resolution Extensive work experience in multiple areas / functions
- Medical claims
- Working knowledge of Microsoft Word to create and save documents, Excel to edit, format, create save spreadsheets and Outlook to send e-mails, set and keep calendar appointment
- Have high-speed internet access
- Certified Coder (CPC/CCS) and / or LPN/RN Licensure
- Licensed Registered Nurse (RN), Licensed Practical Nurse (LPN) or Certified Coder (CPC, RHIT, and / or CCS)
- Experience working with Windows PC software - Microsoft Office: Microsoft Excel (creating / managing spreadsheets, formulas, and pivot tables), Microsoft Word (creating / managing documents)
- Be able to maneuver between computer programs, needs to be able to feel comfortable in web-based applications
6
Experience For Recovery & Resolutions Analyst Resume
- Medicare / Medicaid program knowledge
- CIC (Certified Inpatient Coder) Certification
- COC (Certified Out Patient Coder) Certification
- CPMA (Certified Professional Medical Auditor) Certification
- Experience working with Windows PC software - Microsoft Office: Microsoft Excel (creating / managing spreadsheets, formulas, and pivot tables), Microsoft Word (creating / and managing documents
- Create and modify spreadsheets, documents, and presentations within Microsoft Excel, Word, and PowerPoint
7
Experience For Recovery / Resolutions Analyst Resume
- Experience working with Windows PC software - Microsoft Office: Microsoft Excel (creating / managing spreadsheets, formulas, and pivot tables), Microsoft Word (creating and managing documents)
- Knowledge of Internal and External Policies, Laws and Regulations
- Create and modify spreadsheets, word documents, and PowerPoints within Microsoft Excel, Microsoft Word, and Microsoft PowerPoint
- Create pivot tables in MS Excel
- Attention to detail; Takes initiative
- Organized, Works well in a team
8
Experience For Senior Recovery / Resolutions Analyst Resume
- Create and modify spreadsheets, word documents, and PowerPoints within MS Excel, Word, and PowerPoint
- Experience in Microsoft Office Suite including Excel and PowerPoint ( ability to filter and sort spreadsheets and ability to put together presentations and present them to team members)
- Knowledge of Medicaid/Medicare and familiarity of healthcare industry
- Healthcare claim system knowledge
- Healthcare insurance industry
- Proficient use of multiple screens, systems and platforms simultaneously
- An unrestricted RN or LVN or LPN license
9
Experience For Senior Recovery Resolutions Analyst Resume
- Certified Professional Coder (CPC, CPC-A)
- Use Microsoft Outlook to manage multiple email boxes and calendars
- Demonstrated negotiation experience, specifically in the capacity of persuading and influencing others; ability to negotiate fair settlements consistent with the prevailing subrogation law
- SIU work experience
- Medical Claims, Professional Billing, and / or Collections
- Clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / Physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
List of Typical Skills For a Recovery / Resolutions Analyst Resume
1
Skills For Senior Recovery / Resolutions Analyst Resume
- Experience navigating and editing spreadsheets in MS Excel
- Experience working with medical claims platforms / processing systems
- Experience analyzing and solving customer problems
- Experience using 2 or more of the following Claims Platforms: ODAR, UNET, COSMOS, CPW, ISET, NICE, FACETS, CSP, and / or Oxford
- Experience working with computers-Windows PC applications and MS Excel – Create/Update spreadsheet
- Experience analyzing data to produce actionable outcomes
2
Skills For Senior Recovery Resolutions Analyst Resume
- Experience working with cross functional teams to deliver successful outcomes
- Experience working with Windows based PC Applications
- Experience working with Medicaid, Medicare and Commercial Insurance entities as well as with paid claims data required
- Experience in using Excel to create and maintain spreadsheets, merge cells,
- Experience in using Outlook to send emails, create appointments and use webex
- Experience using claims platforms such as COSMOS, CSP, UNET, Pulse, NICE, Facets, Diamond, etc
- Experience with CPT coding / medical record review
- Intermediate level experience with Microsoft Office tools (including Pivot tables in MS Excel)
- Experience with healthcare claims processing or data entry
3
Skills For Recovery Resolutions Analyst Resume
- Advanced knowledge and experience working on various approaches to health care fraud
- Certified coder or coding experience
- Experience working in a fast-paced, high volume production/metric based environment
- Experience working in a Special Investigations Unit (SIU)
- Experience working in a production environment with metrics and QA standards
- Experience working in a Hospital, Physician's office, or Medical Clinic environment
- Top Loss experience
4
Skills For Recovery / Resolutions Analyst Telecommute Resume
- Experience with Microsoft Excel (can create pivot tables)
- Experience with Outlook (create and send emails, be able to use the calendar and Word (create and edit documents)
- MS Office experience in MS Word and Outlook, with the ability to create, edit, save and send documents
- Work experience in the healthcare insurance industry
- Nursing / coding experience (surgical, hospital, clinic settings)
- Experience with training and / or coaching
5
Skills For Senior Recovery & Resolutions Analyst Resume
- Experience monitoring / managing inventory levels
- Experience running and presenting reports
- Experience with Microsoft Excel (creating charts, graphs, formulas, and import / export data)
- Experience in health care including knowledge of Medicaid / Medicare Reimbursement methodologies
- Experience with Claims Payment Accuracy
- Experience with Recovery of Claims Payments
6
Skills For Recovery & Resolutions Analyst Resume
- Experience with Develop / Manage / Maintain Internal and External Relationships
- Experience with Microsoft Excel (analyze data, filter, sort)
- Experience with Microsoft Outlook (create and send emails, calendar management) and Microsoft Word (create and edit documents)
- 6+ months of health insurance claims experience
- Willing to become a subject matter on current and future department processes and procedures
- Scheduling of dispute resolution meetings
- Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, long periods working at a computer
- Working with MS Excel - Creating, updating and analyzing data on spreadsheets
- Claim coding, auditing, or working in a medical setting
7
Skills For Recovery / Resolutions Analyst Resume
- Moderate proficiency with Microsoft Office including Microsoft Word (creating and navigating documents) and Microsoft Excel (creating spreadsheets, formulas)
- Proficient with personal computers, including word-processing and spreadsheets
- Multiple coding and auditing certifications
- Use Microsoft Excel to analyze data, formatting, and creating charts / tables
- Handle incoming / outgoing calls from healthcare providers
- Monitor and manage call and review case load, ensuring expedient review resolution and routing for all provider calls
- Participate in all meetings and training sessions to understand specifics of auditing each claim type
8
Skills For Senior Recovery / Resolutions Analyst Resume
- MS Office – intermediate level Excel knowledge(using formulas, pivot tables, v-lookup)
- Familiarity of self- funding, Medicare guidelines, COBRA, Subrogation, DOL and HIPAA compliance
- Proficiency with computer and Windows PC applications, comfortable using multiple screens
- Possess an unrestricted nursing license (RN / LVN / LPN) or are a current certified coder (CPC / CCS / RHIT etc.)
- Knowledge of the following Claims platforms: COSMOS; CPW; CSP; Diamond; Facets; NICE
- Use Microsoft Excel (create pivot tables, and use spreadsheet for tracking)
- Unrestricted RN or LVN or LPN license or and / a current certified coder including RHIT (Registered Health Information Technician)
- Knowledge of diagnosis codes and CPT coding guidelines, medical terminology; anatomy and physiology; and Medicare and Medicaid reimbursement guidelines
9
Skills For Senior Recovery Resolutions Analyst Resume
- Proficiency within Microsoft Excel (ability to create pivot tables, and use spreadsheet for tracking)
- Health care claims processing or data entry
- 6+ months of Microsoft Excel - including pivot tables and formulas
- Working in a production environment
- An understanding of Paralegal Studies, Subrogation Principles, Health Insurance and / or P&C Insurance
- Knowledge of Local, State and Federal Laws and Regulations pertaining to Insurance
- Monitor and manage review case load, ensuring expedient review resolution
- Analyze and Identify trends in high scoring providers and prepare providers for Flag Presentation to Client
10
Skills For Recovery Resolutions Analyst Resume
- Desire to train and mentor incoming and current staff to ensure staff and department success
- An unrestricted RN or LVN or LPN license or and / a current certified coder including RHIT
- Data entry for all calls, documentation, mail tracking and review outcomes
- Participate with all aspects of letter mailings to include qa of letters, generating letters and labels
- Present results of analysis in writing and / or verbally to supports the Plan’s rights
- Us MS Excel to be able to create Pivot tables
- Familiar with CPT Code Terminology
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