Samantha Jensen
Rockford,IL
Summary
Epic Certified Professional Billing and Claims, Security and Remittance Analyst. 10+ years background in Healthcare Billing. Completed 6 Epic Go-Live implementations from discovery, through integrated testing and post-live support. Advanced sFTP file transfer, 837/835 and 277 spec setup implementing 3rd party vendor clearinghouses and banking partners. Claim Attachments, Rural Health and FQHC, Special Billing configuration.
Overview
8
8
years of professional experience
1
1
Certification
Work History
PB Claims Consultant
Franciscan Missionaries of Our Lady Health System
03.2023 - Current
- Following organization standards, build and validate new Community Connect service areas
- Designs or modifies procedures to solve complex service tickets
- Works at the highest technical level of all phases of Professional Billing, Claims and Remittance implementation as a team expert who advises and mentors as needed
- Efficient analysis and documentation of CMS requirements, gaps, issues, risks, and enhancements
- Performs a variety of tasks to support customers and management including Access and Security updates, Change Management Team Representation, On-Call duties as assigned.
PB Claims Consultant
AdventHealth
11.2022 - 02.2023
- Lead PB Claims analyst during Wave 3 and 4 Epic Implementation
- Build, test and support the professional billing, claims and remittance modules
- On-site go-live support and on-call for team members
- Data migration support
- Vendor and third-party setup, troubleshooting and monitoring
- 835 remittance configuration, file movement jobs, file directory creation and automated imports.
PB Claims Consultant
Valley Health Systems
06.2022 - 10.2022
- Implementation analyst on the PB Claims team
- Responsible for the review, testing and build tasks in Epic Orion
- Supported Professional Billing tasks including SmartText statements, Follow-up WQ configuration, Credit and PLB routing, Clearing Account Build and batch job setup
- Served as additional Security resource during Go-live
- Led vendor implementation and troubleshooting for file transfers, sFTP directory structure, automated external MoveIt jobs and secure attachment setup
- Configured 837 claims file printing and exports, 835 remittance imports and self-pay posting module settings
- Worked closely with operations on decision making workgroups and workflow revisions
- Managed the PERL splitter to separate legacy payments from Epic invoice payments.
PB Claims Analyst
MedExpress Urgent Care
06.2022 - 09.2022
- Brought on short timeline project to aide in testing efforts
- Completed Unit testing, Claim scenario testing and Volume testing
- Worked with Ambulatory, Prelude, Cadence and facility structure teams to configure multiple tax ID overrides
- Executed claim form, claim edit/rules and workqueue build
- Led electronic remittance efforts with clearinghouse and bank vendors to successfully receive and import insurance payment files into Epic
- Facilitated file transfer processes to send and receive 837/277 files
- Built import specs to read files sent to health system including converted EOBs, cash coupons, patient payments and self-pay checks.
PB Claims Consultant
ProHEALTH
11.2020 - 09.2022
- Professional billing and claims analyst brought on for clinic implementation in New York
- Supported PB team with building claim forms, workqueues, remittance records and configuration
- Led File transfer processes for claims and remittance setup, clearinghouse and vendor communication and configuration
- Active role in integrated testing, PRCT and specialty billing scenarios
- Responsible for analyzing workflows and understanding policies, procedures and constraints in any of the following Access and Revenue business areas: access, billing, claims supported by the EPIC application
- Performs in depth and precise investigation and documentation of business operational specifications and application functionality
- Participates in the application build, test, and support.
PB Claims and Remittance Analyst
Oregon Medical Group
12.2021 - 03.2022
- Implementation and go-live PB claims and remittance duties
- Configured 835/837 and 277 file transfers, vendor connections and Epic imports
- Claims, remittance and follow-up workqueue build
- Identified external claims errors with clearinghouse and built internal edits to increase accepted claims rates
- Established nightly processing jobs, status file mapping and automation
- Worked closely with revenue cycle operations to identify workflows for system automation
- Monitored and resolved post go-live tickets.
- Increased efficiency by streamlining data analysis processes and implementing automation tools.
PB Consultant
New Jersey Urology
04.2021 - 10.2021
- Consulted with clients to identify operational goals and needs then translates the client's needs into detail requirement specifications
- Documented the current state workflows
- Reviewed, analyzed, and modified designated systems including completing configuration, testing, and documentation
- Ensured client engagement expectations and deliverable deadlines were met
- Prepared and completed action plans, determined system improvements, resolved problems, and implemented necessary changes as identified
- Maintained Follow-up workqueue profile, claim edit configurations and remittance plan mapping
- Met regularly with operations and other IT analysts to identify workflow improvement opportunities
- Completed build, testing and data migration to install Epic fixes, updates and operational asks.
PB Team Lead Analyst/Application Coordinator
AltaMed
04.2020 - 11.2020
- Managed services employee working for two hospital systems for build, break/fix and Upgrade related tasks
- Identifying and implementing requested changes to the system
- Building relationships with end users and providing consistent support through day-to-day communication
- Communicating problem status and solutions to end users
- Analyzing and communicating the impact of issues
- Extensive knowledge and working ability to diagnosis, build and test Claims, Remits, Charge Router actions and tasks, workqueue routing and filer rules, Service Area and Facility profile build, claim runs, batch jobs, 277 claims reconciliation and payor and plan build
- Lead large projects including identifying volume loss and variances to clearing house, professional billing revenue tracking, Covid Telemedicine and Telephone build and implementation
- Works in ServiceNow and TrackIt.
EPIC Resolute Professional Billing, Claims Analyst (Revenue Cycle Systems Analyst)
SwedishAmerican Health System
05.2018 - 04.2020
- Works with the I.S
- Team members, vendors and customers to ensure that the Epic Resolute Professional Billing system is properly maintained and necessary changes are reliably tested, documented, and implemented
- Monitor and resolve post-implementation support tickets, as assigned
- Works on version upgrades, Refuel efforts and software patch implementations
- Attends weekly team meetings to discuss team and project related activities, issues, change, communications, and updates
- Coordinates program and/or data moves from development to test/education and production regions working independently, while mentoring/assisting others
- Develops effective relationships with end-users and other team members to enhance the timeliness and effectiveness of technology solutions
- Assists practice users with claims/denial issues to prevent revenue loss
- Identifies areas for workflow and process improvement
- Develops solutions and collaborates with the team and management to implement these solutions
- Strong understanding of upstream and downstream data sources in order to investigate the root causes of claims errors.
Reimbursement Specialist
Firstsource Solutions, LTD
08.2015 - 05.2018
- Processing and adjusting professional outpatient medical claims according to departmental quality and production standards
- Following up for resolution and processing pended claims immediately following a benefit or payment determination
- Identifying errors or inconsistencies that require revisions to claim guidelines or system modifications
- Determining medical record review documents and case management
- Ensuring adherence to federal compliance policies per client contracts
- Spreadsheet and data analytics
- Collaboration with Fraud, Waste & Abuse investigations.
Education
AA in Business Administration -
Rock Valley College
Rockford, IL01.2024
Skills
- Epic
- Analytics
- ServiceNow
- Data Analytics
- Systems Analysis
- Change Management
- Microsoft SharePoint
- Project Leadership
- Process Improvement
- Unit Testing
- Software Troubleshooting
- User Acceptance Testing
Certification
- Resolute Professional Billing Administration including Single Billing Office Certification (08/2018)
- Resolute Professional Billing Claims Administration Certification (10/2018)
- Resolute Professional Billing Electronic Remittance Certification (08/2019)
- Security Certification (02/2019)
- Resolute Hospital Billing Administration including Single Billing Office Certification (03/2020)
Timeline
PB Claims Consultant
Franciscan Missionaries of Our Lady Health System
03.2023 - Current
PB Claims Consultant
AdventHealth
11.2022 - 02.2023
PB Claims Consultant
Valley Health Systems
06.2022 - 10.2022
PB Claims Analyst
MedExpress Urgent Care
06.2022 - 09.2022
PB Claims and Remittance Analyst
Oregon Medical Group
12.2021 - 03.2022
PB Consultant
New Jersey Urology
04.2021 - 10.2021
PB Claims Consultant
ProHEALTH
11.2020 - 09.2022
PB Team Lead Analyst/Application Coordinator
AltaMed
04.2020 - 11.2020
EPIC Resolute Professional Billing, Claims Analyst (Revenue Cycle Systems Analyst)
SwedishAmerican Health System
05.2018 - 04.2020
Reimbursement Specialist
Firstsource Solutions, LTD
08.2015 - 05.2018
AA in Business Administration -
Rock Valley College
Similar Profiles
Jason IveyJason Ivey
Registered Nurse, Emergency Department at Franciscan Missionaries Of Our Lady Health SystemRegistered Nurse, Emergency Department at Franciscan Missionaries Of Our Lady Health System
Paige LawrencePaige Lawrence
Nurse Technician at Franciscan Missionaries of Our Lady Health System - Saint Francis Medical CenterNurse Technician at Franciscan Missionaries of Our Lady Health System - Saint Francis Medical Center
Carissa SimmonsCarissa Simmons
Registered Nurse at Franciscan Missionaries of Our Lady Health SystemRegistered Nurse at Franciscan Missionaries of Our Lady Health System
Summer D. JacksonSummer D. Jackson
Organizational Devlopment Specialist II at Franciscan Missionaries Of Our Lady Health SystemOrganizational Devlopment Specialist II at Franciscan Missionaries Of Our Lady Health System
Erika ZammitErika Zammit
Retail Sales Associate at Kohl'sRetail Sales Associate at Kohl's