Summary
Overview
Work History
Education
Skills
Timeline
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Tiana Buchanan

Murfreesboro,TN

Summary

Highly skilled and results-driven Payment Integrity Business Analyst with several years Data Mining experience. Excellent collaborator who manages interdependent relationships with the director, doctors, nurses and other hospital/professional personnel. Innovative thinker who supports our vendors to succeed in payment integrity.

Overview

9
9
years of professional experience

Work History

Payment Integrity Business Analyst

Optum Care Delivery Services
Franklin, TN
10.2022 - Current
  • Guide Payment Integrity initiatives, focusing on concept and cost avoidance development.
  • Serves as a SME for all Payment Integrity functions in Data Mining
  • Investigating and reviewing the application of medical reimbursement policies within the claim adjudication process through data review
  • Implementation and management of Payment Integrity Programs related to Audit and Recovery Operations
  • Creating documents to aid in the automation of processes
  • Prepare reports received from our internal/external vendors for overpayment adjustment requests
  • Creating reports for tracking adjustment issues to minimize provider abrasion
  • Proficiency in performing financial analysis/audit including statistical calculation and interpretation
  • Review claims to determine outcome of appeals
  • Review new overpayment concepts for the approval process

Recovery/Resolution Analyst, Sr

Optum Insight
Franklin, TN
03.2015 - 10.2022
  • Performed post-payment claim audits for overpayments as a member of the Payment Integrity Data Mining team.
  • Conducted research on appeals to determine their outcome
  • Analyzed contracts for patterns indicating possible overpayment scenarios
  • Generated reports for monitoring overpayment submissions

Education

Some College (No Degree) - Healthcare Management

Middle Tennessee State University
Murfreesboro, TN

Skills

  • Excel
  • Word
  • Outlook
  • FACETS
  • QNXT
  • DOC360
  • Macess
  • Power BI
  • Encoder Pro
  • Claims Adjudication
  • Quality Assurance
  • Claims Auditing
  • Data Mining
  • Automation

Timeline

Payment Integrity Business Analyst

Optum Care Delivery Services
10.2022 - Current

Recovery/Resolution Analyst, Sr

Optum Insight
03.2015 - 10.2022

Some College (No Degree) - Healthcare Management

Middle Tennessee State University

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Tiana Buchanan