Mark Moya
Summary
Dedicated healthcare revenue cycle professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
26
26
years of professional experience
Work History
Business Analyst
Experian Health, MPV
San Antonio, Texas
10.2021 - Current
- Applied honed problem-solving skills to analyze and resolve issues impacting business operations and goal achievement
- Improved business direction by prioritizing customers and implementing changes based on collected feedback
- Consulted with product development teams to enhance products based on customer interest data
- Collaborated with system architects, design analysts and others to understand business and industry requirements
- Developed database architectural strategies at modeling, design, and implementation stages to address business or industry requirements
- Used critical thinking to break down problems, evaluate solutions and make decisions.
Reimbursement Analyst
05.2016 - 09.2021
- Consulted with product development teams to enhance products based on customer interest data
- Collaborated with system architects, design analysts and others to understand business and industry requirements
- Developed database architectural strategies at modeling, design, and implementation stages to address business or industry requirements
- Used critical thinking to break down problems, evaluate solutions and make decisions
- Developed product documentation to communicate and align key components of upcoming features and products to internal teams
- Worked with development team to define and implement customer change requests to enhance product functionality
- Supported development team in generation of technical requirements and product documentation to achieve process commonality
- Worked with software development team on reported errors and bugs on newly released software and assisted in deployment of release fixes
- Coordinated with software developers to create custom applications and trackers to achieve client goals
- Planned and arranged meetings with external organizations and individuals, enabling parties to meet and discuss project progress
- Suggested enhancements to product design that would improve user experience
- Brainstormed with peers and other members of design team to determine enhancements and product features.
Definition Analyst, Senior
09.2014 - 05.2016
- Review, analyze, and models managed care contracts
- Create/Maintain a preliminary Contract List in Contract Manager
- Request, pursue, and thoroughly analyze contract information from contracting entities for each identified contract throughout the implementation process
- Define, load, and test contract variables
- Create mapping table which relates the Experian Healthcare contract code to the appropriate practice management system (PMS) and Hospital Information System (HIS) contractual identifier(s) and forward to Development
- Prepare Experian Health Contract Code List to be utilized during EOB Analysis training and e-mail to Training Department
- Acts as a resource for questions related to valuation accuracy and/or additional technical issues that may arise during the contract quality assurance and/or claim data reconciliation processes
- Assist in the development of policies and procedures for contract definition
- Assist in the Hospital Logic by provided specs to the engineers
- Attend and participate in internal and client meetings as needed
- Assist sales in Contract Management Hospital Demo's
- Assist in training new contract definition analyst and QA employee's work
Appeal Analyst
11.2010 - 09.2014
- Implements process for identifying under-allowed claims using Contract Management and other available tools
- Reviews and analyzes EOBs (Explanation of Benefits) for identified under-allowed claims
- Verifies applicable contract by, as dictated by operational procedures: reviewing EOB messages, reviewing patient ID card, verifying member information for managed care plans
- Uses feedback and experience to refine communication skills and tools for us in preparing written and telephone appeals
- Batches appeals by payer or network, by CPT/HCPCS code combination, by error type, or by provider
- Compiles and submits appeals, and monitors for proper reimbursement
- Uses Contract Management to track appeals and recoveries
- Establishes and cultivates helpful and effective contacts in payer or network offices
- Establishes follow-up protocol with payers and networks
- Prepares monthly performance statistics regarding appeals and recoveries
- Monitors and tracks contractual, billing, registration, posting errors, and provides continuous feedback to Appeals Manager
- Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
- Maintains the strict confidentiality required for medical records and other data
- Participates in professional development efforts to ensure currency in managed care reimbursement trends
Support Appeal Analyst
02.2009 - 10.2010
- Demonstrate effectively communicate, resolve issues, improve processes, establish, and prioritize goals
- Interpret insurance company contract to determine accurate reimbursement
- Performed second validation of underpayment discrepancy/variance
- Contacted insurance company, initiated request for payment, and follow up with insurance company for as appropriate
- Identify overpayment and underpayment trends to manager and client
- Assisted one of our clients with revenue gain from a 1 million to 2 million client within a year
Insurance Reimbursement Specialist
Baptist Health System
San Antonio, Texas
07.2008 - 02.2009
- Perform and validate refund request from insurance companies and financial recovery agencies
- Initiate refunds of identified overpayments and resolve open discrepancies
- Monitor takebacks and initiate refunds as appropriate
- Research returned refund checks and take the necessary action to resolve
- Identify problem accounts/processes/trends and escalate as appropriate
- Utilize effective documentation standards that support a strong historical record of actions taken on the account
- Ability to perform basic math to ensure accurate statement of accounts receivable
- Meet the productivity and quality standards of the organization
- Timely completion and comprehension of all educational requirements
Underpayment Team Leader
HCA Healthcare
San Antonio, Texas
04.2007 - 05.2008
- Supervise a team of fourteenth employee with daily questions on process and managed employee time sheets
- Providing introductory and ongoing training and education to staff to ensure that policies and procedures are implemented
- Demonstrate effectively communicate, resolve issues, improve processes, establish, and prioritize goals
- Improve staff communication, providing updates, resolving issues, setting goals, and maintaining standards
- Interpret insurance company contract to determine accurate reimbursement
- Performed and validate discrepancy reason coding of underpayment inventory
- Pursue additional payment from payers on underpayment discrepancies through various means of communications, such as telephonically, online, or via payment package processes
- Overcome objections that prevent payment of the claim
- Gain commitment for payment through concise and factual collections techniques
- Facilitate corrections of non-payment related underpayment discrepancies through I-plan changes or coordinate with other departments as needed
- Identify and communicate trends to management, including those that might be appropriate for the dispute resolutions process
- Escalate accounts to appropriate individuals at the payer and via management as needed, including accounts with lack of timely payer response
- Utilize effective documentation standards that support a strong historical record of actions taken on the account
- Collaborate with Contract/Modeling Personnel to identify, resolve specific issues with insurance companies and escalated contract issues to the Manager
- Assisted other departments with accounts receivable reports, month-end reports, and outsource vendors such as Triage, AIMS, and other department within the organization
- Responsible to minimize cost within the department such as supplies and time management
- Responsible to review the A/R for potential revenue and report on month end reports
Quality Assurance Analyst
05.2006 - 04.2007
- Created and achieved product quality objectives and met product specifications
- Supported company in maintaining work environment focused on quality, communication, collaboration, integration and teamwork
- Analyzed and tested different builds to identify, trace and help resolve bugs
- Researched new tools and technologies for potential use by quality assurance team
- Determined root cause of deviations and non-conforming results and implemented appropriate corrective and preventive actions throughout product development process
- Documented and executed detailed test plans and test cases and summarized and logged audit findings for reporting purposes
- Developed and audited practices, programs and reporting system metrics for optimal efficiency
- Developed monthly, end-of-quarter, and other statistical reports for leadership team and quality improvement programs.
Manage Care Discrepancy Analyst
06.2002 - 05.2006
- Demonstrate effectively communicate, resolve issues, improve processes, establish, and prioritize goals
- Improve staff communication, providing updates, resolving issues, setting goals, and maintaining standards
- Interpret insurance company contract to determine accurate reimbursement
- Performed and validate discrepancy and assigned appropriate underpayment, overpayment, and denial reason code
- Research and resolved patient accounts that have any discrepancies
- Verify accuracy of payment received from insurance
- Contacted insurance companies and patients as needed to verify appropriate insurance plan coverage
- Assigned appropriate collections series and forwarded to appropriate area for follow up
- Collaborate with Contract/Modeling Personnel to identify and resolve specific issues with Payers
- Assist on special projects including month-end reports and auditing functions
- Involved in department interview process and served as a Mentor/trainer for incoming analysts
- Assist team leader and manager to ensure accuracy and timely processing of all transactions
- Maintaining Discrepancy Web Tool and Managed Care Logging System
Patient Registrar
09.2001 - 06.2002
- Greeted patients warmly to increase comfort and create rapport
- Accurately inputted patient and insurance information into company's computer system using Meditech
- Verified insurance information, collected payment or co-payment for services and created record of visit for future billing
- Collected information, forms and signatures from patients or family members to create efficient admissions experience
- Verified patient details and insurance coverage and collected co-pays
- Handled admission processes and discharge procedures to transfer patients from hospital to home care, extended facility, and self-care plans.
Labor & Delivery Unit Secretary – Patient Registrar
Baptist Health System
San Antonio, Texas
08.1997 - 09.2001
- Greeted patients warmly to increase comfort and create rapport
- Accurately inputted patient and insurance information into company's computer system using Meditech
- Verified insurance information, collected payment or co-payment for services and created record of visit for future billing
- Collected information, forms and signatures from patients or family members to create efficient admissions experience
- Verified patient details and insurance coverage and collected co-pays
- Handled admission processes and discharge procedures to transfer patients from hospital to home care, extended facility and self-care plans
- Managed incoming calls and directed to appropriate department
- Organized paperwork such as charts and reports for office and patient needs
- Maintained rapport with physicians, nurse,s and other healthcare personnel
- Maintained current and accurate medical records for patients
- Processed lab paperwork and requests according to physicians' orders
- Supported office staff and operational requirements with administrative tasks
- Monitored inventory levels and advised management of need for replenishment
- Placed new supply orders, managed inventory and restocked clerical spaces
- Received and routed laboratory results to correct clinical staff members.
Admission Registrar/Patient Escort
Methodist Health System
San Antonio, TX
08.1995 - 08.1997
- Greeted patients warmly to increase comfort and create rapport
- Accurately inputted patient and insurance information into company's computer system using Meditech
- Verified insurance information, collected payment or co-payment for services and created record of visit for future billing
- Collected information, forms and signatures from patients or family members to create efficient admissions experience
- Verified patient details and insurance coverage and collected co-pays
- Handled admission processes and discharge procedures to transfer patients from hospital to home care, extended facility, and self-care plans.
Education
Bachelor of Business Administration - Management
Texas A & M University
San Antonio, TX12.2011
Associates of Science - Accounting
Palo Alto College
San Antonio, TX05.2007
Skills
- Atlassian JIRA
- Salesforce Lightning
- Agile and Scrum Environments
- Flexible & Adaptable
- Collaboration
- Self-Motivated
- Microsoft Excel
- Microsoft Office
- Conflict Resolution
- Customer Service
- Complex Problem-Solving
- Decision Making
- Analytical Thinking
Traveling
I love to travel to different places, seeing new sights, exploring different cultures. I enjoy beautiful places and admire the beauty of the natural attractions such as mountains, waterfalls, forest, lakes and oceans with with my friends or family.
Timeline
Business Analyst
Experian Health, MPV
10.2021 - Current
Reimbursement Analyst
05.2016 - 09.2021
Definition Analyst, Senior
09.2014 - 05.2016
Appeal Analyst
11.2010 - 09.2014
Support Appeal Analyst
02.2009 - 10.2010
Insurance Reimbursement Specialist
Baptist Health System
07.2008 - 02.2009
Underpayment Team Leader
HCA Healthcare
04.2007 - 05.2008
Quality Assurance Analyst
05.2006 - 04.2007
Manage Care Discrepancy Analyst
06.2002 - 05.2006
Patient Registrar
09.2001 - 06.2002
Labor & Delivery Unit Secretary – Patient Registrar
Baptist Health System
08.1997 - 09.2001
Admission Registrar/Patient Escort
Methodist Health System
08.1995 - 08.1997
Bachelor of Business Administration - Management
Texas A & M University
Associates of Science - Accounting
Palo Alto College
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