Amanda Rousary
Stickney ,IL
Summary
Healthcare revenue professional with 6+ years of progressive experience in Medicare Advantage premium reconciliation, eligibility, revenue recovery, and discrepancy resolution. Specialized in End- Stage Renal Disease (ESRD) and Medicare Secondary Payer (MSP), with experience analyzing CMS-related payment issues, determining financial impact, supporting corrective actions, and guiding analysts through complex cases. Strong focus on accuracy, compliance, process improvement, and cross functional collaboration.
Overview
7
7
years of professional experience
Work History
Revenue Analyst
Blue Cross Blue Shield of Illinois
12.2023 - Current
- Lead ESRD/ MSP recovery and Medicare Advantage premium reconciliation activities. ensuring complex cases and payment discrepancies are researched, resolved, and processed accurately.
- Use facets to analyze member eligibility, Medicare entitlement, claims, payment history, and coordination -of - benefits information to identify retroactive recovery opportunities and payer responsibility.
- Conduct complex discrepancy and root - cause analysis identify CMS- related actions .
- Serve as an ESRD/MSP resource and escalation point, providing guidance, mentorship, and complex- case support to analysts while helping coordinate workload priorities.
- Partner with enrollment. Finance, IT, leadership, and other business areas to resolve high - impact issues, support reporting and audit requirements, and drive improvements in accuracy, efficiency, and revenue recovery.
Eligibility Verifier
Duly Health And Care
01.2020 - 12.2023
- Update benefit options for patient records with accurate, current insurance policy information.
- Generated eligibility reconciliation reports to ensure all members are appropriately reflected in health plan enrollment systems.
- Generated reports for new members and added a Primary care physician to member charts.
- Ensures new member materials are mailed out accurately and in a timely manner.
- Generates all termination letters for primary care physicians and mail letter material to members.
- Ensures accurate and timely eligibility records of member enrollment and changes for plans.
- Maintains provider eligibility verifications of member enrollment.
- Implemented test to validate corrections and solutions.
- process audit requests in appropriate timeframe.
- Complied with HIPAA guidelines and regulations for confidential patient data.
Education
High School Diploma -
Lyons Township High School
La Grange, ILSkills
- ESRD & MSP
- Medicare Advantage Premium Reconciliation
- Facets
- CMS Payment Analysis
- Revenue Recovery
- Claims & Eligibility Analysis
- Root cause Analysis
- Financial Impact Analysis
- Reporting & Audit support
- Process Improvement
- Analyst Guidance & Mentorship
- Cross- Functional Collaboration
- Microsoft Excel
- HIPAA
Timeline
Revenue Analyst
Blue Cross Blue Shield of Illinois
12.2023 - Current
Eligibility Verifier
Duly Health And Care
01.2020 - 12.2023
High School Diploma -
Lyons Township High School