Angela N. Brown
Summary
Highly knowledgeable Healthcare Analyst with wealth of healthcare revenue cycle experience and expertise in problem-solving. Talented in maintaining complex and comprehensive databases covering patient information. Dedicated to proactive monitoring and thorough reporting using top-notch technical abilities.
Overview
16
16
years of professional experience
Work History
Claims Business Analyst
Optomi, Conduent
03.2023 - Current
- Implementing /maintenance of commercial payer claims solution and/or Medicare/Medicaid system
- Claims processing concepts, along with the provider, member enrollment and care management concepts
- Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs
- Configuring benefits or programs in claims system across various sub-systems
- Work with the clients to create/gather requirements and document them according to standards
- Define the processes for requirement solicitation, documentation and hand off
- Work closely with the IT development team to elucidate the requirements, enable constructive discussions / brainstorming sessions to implement the best-in-class solution
- Run queries and perform basic system analysis, RCA etc.
- Create mapping documents for the various interfaces and include business rules, transformation, and DB mapping.
Claims Analyst
TEKsystems
03.2022 - 03.2023
- Banner Health
- Remote
- Create & maintain a library of test cases utilized for IDX configuration changes, both manually executed and for automated testing
- Utilizing IDX software Examine claims forms and other records to determine insurance coverage
- Perform testing (write, execute and report on test cases) of IDX configuration changes to ensure proper claims payment for Banner Health fee schedules, benefit plans, provider agreements & contract arrangements, clinical editing, authorizations and general system maintenance requests
- Update provider contracts with bill types, revenue codes, CPT/HCPCS, procedure codes, ICD9/10 diagnosis codes, Per Diem and Case Rates and DRG codes on a yearly basis or as determined by the provider contract.
Healthcare Analyst
Optimized Manpower, State of New Jersey, DHMAS
03.2007 - 01.2020
- Update and maintain all databases/spreadsheets for Medicaid Receipts
- Establishing and enforcing budgets and timelines
- Update provider contracts with bill types, revenue codes, CPT/HCPCS, procedure codes, ICD9/10 diagnosis codes, Per Diem and Case Rates and DRG codes on a yearly basis or as determined by the provider contract
- Responsible for repricing claims and processing Using 3M Grouping software
- Reviews denied cases by using pre-established criteria and determines whether or not an appeal is warranted for DRG appeals
- Ensure that all facility contracts received are accurately and timely logged within the Contract Control Log and reviewed and configured services and corresponding rates/reimbursement methodologies (i.e
- DRG, APG, APC, ASC etc) in the provider contracting system
Healthcare Consultant
Integrated Resources INC, Meritain/AETNA
02.2019 - 01.2020
- Remote
- Review incoming mail and route to correct department or examiner
- Complete pre-authorization request
- Data entry and repricing of Transplants claims
OP PBS Medical Billing Specialist
Office Practicum
07.2018 - 02.2019
- Gather Billing information by reviewing physician created super-bills, checking for completeness
- Convert Super-bills that are ready to be billed to claims and apply proper modifiers if not blocked and substituted
- Bill carriers by inputting billing information into Office Practicum and initiating electronic transmissions
- Log into Clearinghouses and check previous days' claims that were submitted, if any rejections, fix immediately (if fixed in clearinghouse, also fix claim in OP)
- Ensure all claims are submitted with a goal of zero errors
- Enter hospital charges (if any)
- Submit insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 forms
- Assists in the research and correction of billing errors.
Credentialing Specialist
FLUID EDGE Consulting, Einstein Medical Center
08.2017 - 07.2018
- Successfully led Credentialing Improvement Project to decrease credentialing processing times
- Utilizing FACETS to update all providers in for motion for Enrollment purposes
- Created standardized system process while adhering to NCQA and Corporate guidelines
- Validated Provider data received electronically for accuracy and completeness during the Facility credentialing process
- Provided training for front to back credentialing process.
ACCOUNT MANAGER
GREENKEY SOLUTIONS//PHILADELPHIA MENTAL HEALTH CENTER
08.2017 - 02.2018
- Responsibilities included payment posting of Explanation of Benefits, Charge Entry, also Payment adjustments utilizing Credible
- Handled insurance verification using Naivnet and Promise
- Submission of HCFA electronically and paper Using Credible Software
- Performing small system configuration analysis
- Provider credentialing of mental health providers for Commercial, Medicaid and Medicare
CHARGE ENTRY CLERK
GLOBAL INSIGHT//COOPER HEALTH
10.2016 - 08.2017
- Performed weekly chart audits for checking of appropriate codes
- Entered billing data and submitted bills to insurance companies' private payers Medicaid and Medicare
- Identified issues and brought any to the attention of supervisor
- Documented and maintained all records as required
- Engaged in collections activities and met AR goals.
FACETS CONFIGURATION ANALYST/QUALITY CONTROL AUDITOR
TRIZETTO CORPORATION
02.2016 - 10.2016
- Performing system configuration analysis, design, coding, and unit testing for simple to medium complex customer specific solutions
- Following established processes, standards and procedures designed to minimize service level
- Agreement violations
- Analyzing less complex customers' business requirements and software/product objectives; performing design, configuration and unit tests
- Supporting and maintaining application designs to meet the customer needs
- Estimating periods, quality and quantity of resources required to successfully complete activities; developing project plan that incorporates all project variables
- Conducting routine audits for all operational staff including but not limited to claims, data entry, and enrollment and charge entry staff, customer service staff and provider file maintenance staff
- Developing, preparing and reporting results of service level and process audits and providing error statements for explanation of errors to audited staff and management
- Providing information to the quality management leadership team regarding the need for group and/or individual training based on audits
- Performing focus audits, creating ad hoc reports and summarizing results for management and/or the client
- Performing system testing to ensure that business processes are functioning as designed and established.
OFFICE TEAM
HORNSTEIN, PLATT & ASSOC
09.2015 - 12.2015
- Responsibilities included payment posting of Explanation of Benefits and Charge Entry utilizing Kero
- Handled insurance verification using Naivnet, Promise and Passport
- Data entered HCFA and UB Forms; handled claims payments and processing of claims; as well as, answered provider and member calls
COOPER HEALTH SYSTEMS
ED REGISTRAR
06.2015 - 09.2015
- Registers all patients in the emergency department (ED) and those admitted in the hospital for observation or inpatient care
- Completes the registration process using IDX Flowcast
- Insurance verification of insurances utilizing Navinet, Passport and all other online tools
- CPT Coding ER Charts
- Other duties such as filing.
UAT FACETS TESTER
UPP TECHNOLOGY INC
01.2015 - 05.2015
- Work with the QA Analyst on root cause analysis for payment issues
- Create & maintain a library of test cases utilized for Facets configuration changes, both manually executed and for automated testing
- Perform testing (write, execute and report on test cases) of Facets configuration changes to ensure proper claims payment including MassHealth and Commonwealth Care fee schedules, benefit plans, provider agreements & contract arrangements, clinical editing, authorizations and general system maintenance requests
- Working Knowledge on different EDI files creation (834, 837 etc.)
- Perform functional testing, data Validations, and regression testing of applications managed by Business Integration such as Trizetto Facets, iCES, NetworX, Workflow and DRG.
ASSOCIATE, CLAIMS ADJUSTER
HIGH POINT SOLUTIONS
03.2014 - 12.2014
- Utilizing Facets and Xcelys software Examine claims forms and other records to determine insurance coverage
- Review insurance policy to determine coverage
- Provide support to claims examiners, customer service and provider claims service reps
- Responds to & resolves provider and health plan claim inquiries.
Education
Dipolma - MEDICAL OFFICE ADMINISTRATION
TEMPLE UNIVERSITY
PHILADELPHIA, PADipolma - Medical Offcie Administration
DPT BUSINESS SCHOOL
PHILADELPHIA, PASkills
- Billing Document Creation
- Benefits Verifications
- Information Updates
- Payments Posting
- Needs Assessment
- Business Tracking
- Data and Analytics
- Claims Analysis
- Data Collections
- Microsoft Excel
- User Acceptance Testing (UAT)
- Claims Reporting
- Team Meetings
- Health Information
Software
- EPIC EMR
- NextGen
- Navinet
- Promise
- IDX GE Centricity
- Facets
- 3M Grouping Software
- Kareo.
Timeline
Claims Business Analyst
Optomi, Conduent
03.2023 - Current
Claims Analyst
TEKsystems
03.2022 - 03.2023
Healthcare Consultant
Integrated Resources INC, Meritain/AETNA
02.2019 - 01.2020
OP PBS Medical Billing Specialist
Office Practicum
07.2018 - 02.2019
Credentialing Specialist
FLUID EDGE Consulting, Einstein Medical Center
08.2017 - 07.2018
ACCOUNT MANAGER
GREENKEY SOLUTIONS//PHILADELPHIA MENTAL HEALTH CENTER
08.2017 - 02.2018
CHARGE ENTRY CLERK
GLOBAL INSIGHT//COOPER HEALTH
10.2016 - 08.2017
FACETS CONFIGURATION ANALYST/QUALITY CONTROL AUDITOR
TRIZETTO CORPORATION
02.2016 - 10.2016
OFFICE TEAM
HORNSTEIN, PLATT & ASSOC
09.2015 - 12.2015
COOPER HEALTH SYSTEMS
ED REGISTRAR
06.2015 - 09.2015
UAT FACETS TESTER
UPP TECHNOLOGY INC
01.2015 - 05.2015
ASSOCIATE, CLAIMS ADJUSTER
HIGH POINT SOLUTIONS
03.2014 - 12.2014
Healthcare Analyst
Optimized Manpower, State of New Jersey, DHMAS
03.2007 - 01.2020
Dipolma - MEDICAL OFFICE ADMINISTRATION
TEMPLE UNIVERSITY
Dipolma - Medical Offcie Administration
DPT BUSINESS SCHOOL