Andrea Deveau Israel
Citrus Heights,CA
Summary
Detail-oriented and experienced Senior Coding Analyst seeking to leverage expertise in claims processing, medical billing, and managed care in a Revenue Analyst II role. With a strong understanding of DRG and CPT/HCPC Medical Coding, Managed Care, and Government reimbursement methodologies, aiming to drive financial efficiency and accuracy in a dynamic healthcare environment.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Senior Coding Analyst, Health Information Administrator
Centene/HealthNet
08.2018 - Current
- Review high dollar claims for appropriate place of service, length of stay, match to authorization, and possible outlier DRG or Stop Loss pricing
- Conduct complex business and operational analyses to assure payments are in compliance with contract; identify areas for improvement and clarification for better operational efficiency
- Work collaboratively with various cross-functional departments to determine appropriateness of pricing
- Serve as technical resource / coding subject matter expert for contract pricing related issues
- Responsible for entire cycle of high dollar claims which includes verifying information on submitted claims, reviewing contracts, compliance guidelines, state regulations, eligibility, and authorizations to determine reimbursement, and releasing claim for payment
- Conduct point of service review and resolution of high dollar claims that are pending and/or adjusted incorrectly including review, investigation, adjustment and resolution of claims, claims appeals, inquiries, and inaccuracies in payment of claims
- Collaborate with all departments to analyze complex claims issues and special claim projects which are identified through high dollar review
- Review inventories to determine appropriate task to complete first and key performance indicators are met
- Manage and provide testing on new product or system configuration to determine success rate of such product or configuration prior to go-live
- Education/Experience: High school diploma or equivalent and 3+ years of claims processing, medical billing, administrative, customer service, call center, physician’s office or other office services experience
- Previous managed care, State and/or Federal health care programs (i.e., Medicaid, Medicare) or health insurance industry experience
- Knowledge of billing practices for hospitals, physicians and/or ancillary providers as well as knowledge about contracting and claims processing
- Licenses, (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CSS), Professional Coder-Payer (CPC-P) certification, Certified Professional Coder (CPC) or related certifications preferred.
Advanced Claims Analyst
08.2017 - 08.2018
- Processed and adjusted medical claims including escalated claims and administrative pay claims, communicated and coordinated claims issues with health plan and customer service departments
- Lines of business including Medicare and Commercial domains
- Subject matter expert for Medicare and claims pricing tools
- One of two analysts chosen to attend first advanced claims analyst training for new claims center.
Appeals and Grievance Coordinator
01.2017 - 05.2017
- Responsible for research and logging of Commercial Appeals and Grievance process including tracking documentation and correspondence related to appeals using Centene and Department of Insurance timelines
- Request medical records and communicate with Centene members regarding Appeals and Grievances and final determination of those cases.
Travel Advisor
Viking Cruises
06.2016 - 09.2016
- Responsible for service calls from booked passengers, travel agents and other travel professionals, identifying needs including handling of complex itineraries and pricing plans and providing solutions
- Processed payments and maintained individual service quality goals and adhered to call center matrix
- Destinations to Recovery
Senior Recovery Specialist
10.2015 - 05.2016
- Created Insurance Collections processes for adolescent dual diagnosis residential treatment facility, OON billing and collections
- Insurance verification, all aspects of billing including posting payments, EOB’s, EOC’S, appealing denials and tracking all aspects of claims
- Set up payment plans with members to insure payment of out of pocket and deductibles
- Increased monthly collections 67% within 2 months of hire
- 100% success rate for Provider disputes/appeals
- QuickBooks entry for invoicing
- Prepared daily deposit from insurance payments and ran weekly aging report.
Senior Administrative Assistant
HOAG Memorial Hospital
12.2014 - 06.2015
- Responsible for all administrative functions for Hospital Engineering department
- Maintained all compliance documentation related to state and regulatory audits
- Prepared department budget, processes invoices and prepares all Engineering related contracts.
Billing Specialist
Connecticut Mental Health Specialist
01.2012 - 01.2014
- Administrative lead for Connecticut’s largest private Geriatric mental health group supporting 47 clinicians serving over 75 facilities
- Liaison between billing company and office, coordinating and trouble shooting billing and collection issues
- Responsible for Medicare, Medicaid and commercial collections using state of art EMR system, refunds, write offs, appeal denied claims, patient intake, insurance verification, document management, all aspects of patient billing including posting payments, EOB’s, billing and collections
- Maintained office supplies and marketing materials, created documents and forms for outpatient facilities.
Secretary II
The Hospital of Central Connecticut, Britain
01.2010 - 01.2012
- Responsible for all administrative support in a 24-hour hospital laboratory including Timekeeping and weekly Payroll
- Responsible for Records Management and ensuring compliance with hospital and HIPAA standards
- Introduced multiple process improvements to streamline workflow, improve lab efficiency and reduce costs.
Unit Secretary
University of Washington Medical Center
01.2010
- Liaison between nursing unit and internal departments
- Maintains and organizes patient medical records
- Transcribes medical orders and maintains equipment and supplies
- Triages high volume of calls to physicians and hospital staff and ability to work under pressure
Patient Coordinator II
Hall Health Student Health Center
01.2009 - 01.2010
- Responsible for scheduling and obtaining insurance authorizations; completed required documentation; responsible for data entry
- Coordinated with billing department to ensure patient compliance with financial obligations to the health center, Vascular Laboratory
- Responsible for complex multi-site scheduling of all inpatient and outpatient Vascular procedures
- Increased patient volume by streamlining referral process and improving design of scheduling software.
Education
BA - Sociology
Northland College
Ashland, WISkills
- Managed Care and Government Reimbursement
- DRG and CPT/HCPC Medical Coding
- Medical Terminology
- Contract Modeling and Revenue Impact Analysis
- Claims Processing and Medical Billing
- Knowledge of Hospital Operations (Revenue Cycle: Registration, Patient Accounting/Billing, Data Processing)
- Understanding of Accounting Principles and Hospital Financial Reporting
Certification
Managed Care and Government Reimbursement
- DRG and CPT/HCPC Medical Coding
- Medical Terminology
- Contract Modeling and Revenue Impact Analysis
- Claims Processing and Medical Billing
- Knowledge of Hospital Operations (Revenue Cycle: Registration, Patient Accounting/Billing, Data Processing)
- Understanding of Accounting Principles and Hospital Financial Reporting
Affiliations
Member, American Health Information Management Association (AHIMA)
Timeline
Senior Coding Analyst, Health Information Administrator
Centene/HealthNet
08.2018 - Current
Advanced Claims Analyst
08.2017 - 08.2018
Appeals and Grievance Coordinator
01.2017 - 05.2017
Travel Advisor
Viking Cruises
06.2016 - 09.2016
Senior Recovery Specialist
10.2015 - 05.2016
Senior Administrative Assistant
HOAG Memorial Hospital
12.2014 - 06.2015
Billing Specialist
Connecticut Mental Health Specialist
01.2012 - 01.2014
Secretary II
The Hospital of Central Connecticut, Britain
01.2010 - 01.2012
Unit Secretary
University of Washington Medical Center
01.2010
Patient Coordinator II
Hall Health Student Health Center
01.2009 - 01.2010
BA - Sociology
Northland College
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