Tou Xiong
Holmen,WI
Summary
Dynamic and detail-oriented Epic Resolute Hospital Billing Claims Analyst with over 8 years of experience in healthcare revenue cycle management. Demonstrates a strong track record of optimizing claims processes, reducing denials, and ensuring compliance with industry standards. Skilled in analyzing complex billing systems and implementing solutions to enhance efficiency and accuracy. Proficient in the full functionality of the Epic Resolute billing system, including claims submission, remittance processing, and account reconciliation. Combines analytical skills with a collaborative approach, working closely with cross-functional teams to foster a culture of continuous improvement and knowledge sharing.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Senior Application Analyst
Gundersen Health System
05.2017 - Current
- Continuously optimize workflows related to claims and remittance for Resolute Hospital, enhancing efficiency and accuracy in claims processing.
- Engage collaboratively with the Revenue Cycle team to identify and thoroughly document the requirements established by payers.
- Led initiatives to implement process improvements to minimize future rejections and denials through comprehensive analysis of patterns and root causes, resulting in enhanced operational efficiency and reduced error rates.
- Leverage Epic's reporting and analytics tools to identify and mitigate bottlenecks in the revenue cycle, enhancing operational efficiency and driving revenue growth.
- Collaborates with cross-functional teams and the Revenue Cycle department to enhance billing integration processes.
- Provide continuous maintenance and support for the 3M Core Grouping Software (CGS) to ensure optimal functionality in Medicare claims processing.
- Leads and organizes short-term projects.
- Provide mentorship to new analysts and consultants, ensuring they become proficient in current workflows and best practices.
- Engage in testing and implementing quarterly upgrades to the Epic system to ensure billing processes remain uninterrupted during the transition.
- Manage and maintain the MOVEit Automation platform to ensure secure, reliable, and compliant file transfers across internal and external systems.
I.T. Systems Process Engineer
Ashley Furniture Industries
06.2014 - 05.2017
- Led the successful integration and deployment of new processing systems, ensuring compatibility with existing IT infrastructure
- Managed the rollout of system updates and patches to improve performance and security across the organization
- Monitored system processing loads and made adjustments to balance workloads effectively
- Designed and maintained data processing workflows, achieving a reduction in processing time while maintaining data integrity
- Collaborated with database administrators to ensure seamless data flow between systems and databases
- Provided expert-level technical support for system processing issues, reducing downtime and maintaining business continuity
- Developed system processing reports for senior management, providing insights into performance metrics and improvement opportunities
- Analyzed system logs and processing patterns to anticipate potential issues before they affected operations
- Collaborated closely with software development teams to provide system processing requirements for new applications
- Collaborated closely with network engineers to ensure seamless connectivity and optimal performance of system processing components
Education
Bachelor of Science - Information Technology
Kaplan University
01.2014
Skills
- Process improvement
- User interface design
- Quality assurance testing
- System administration
- Analytics
- Requirements gathering
- Technical proficiency
- Business analysis
- Product configuration
- Technical documentation
Certification
- CRO201 Charge Router Administration (2019 - Current)
- RHB303 Resolute Hospital Billing Administration (2019 - Current)
- RHB330 Resolute Hospital Billing Claims and Electronic Remittance Administration (2017 - Current)
- ITIL Foundation Certificate in IT Service Management (2015 - Current)
Epic Implementations
Lead Analyst - Affiliate:
- Moundview Hospital, Friendship, WI (2018)
- St. Elizabeth's Hospital, Wabasha, MN (2021)
Lead Analyst - Community Connect:
- Tomah Health, Tomah, WI (2022)
- Crossing Rivers Health, Prairie du Chien, WI (2022)
Epic Build & Master File Experience
- Resolute Hospital Claims and Remittances Build
- Automatic Claim Attachment using ROI
- Automatic System Action Build
- HB Claim Edit Workqueues
- HB Account Workqueues
- Charge Handler Build
- 3M Core Grouper Software (CGS) Administrator
- Payers and Plans Build
- Alternate Payor Build
- State Reporting (WIPOP) Administrator
- Imports & Exports
- EDI 276/277, 835, 837
- EAP Imports (Quarterly and Annually)
- UB04 Data Administrator
Timeline
Senior Application Analyst
Gundersen Health System
05.2017 - Current
I.T. Systems Process Engineer
Ashley Furniture Industries
06.2014 - 05.2017
Bachelor of Science - Information Technology
Kaplan University
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