Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Yvette Vartanian

Sunland,CA

Summary

Professional claims analyst with proven track record in evaluating, processing, and resolving insurance claims. Strong focus on team collaboration and adaptability, ensuring seamless operations and optimal outcomes. Highly skilled in data analysis, risk assessment, and customer service, consistently delivering reliable and efficient results. Known for excellent problem-solving abilities and maintaining high standards in all tasks.

Seeking a position in a well-established company where I can utilize my skills, knowledge, and experience with opportunity to potentially grow.

Overview

25
25
years of professional experience

Work History

Senior Revenue Claims Analyst

City of Hope National Medical Center
10.2022 - Current
  • Maintained strict confidentiality with all personal data as per company guidelines.
  • Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
  • Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
  • Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
  • Reduced claims processing time by implementing efficient analytical techniques and strategies.
  • In accordance with State and Federal laws, identify, investigate and resolve claims under review, returned, disputed, or denied by either a Commercial, HMO or a government payer (e.g. Blue Cross Blue Shield or Medicare) etc.
  • Perform detailed review and analysis to investigate audit requests from Commercial, Medicare Recovery Audit Contractors.
  • Determine why a claim is under review, in dispute, or was denied. Coordinate with various internal departments ensuring all appropriate documentation is obtained to respond to audit requests appropriately.
  • Ensure all requests for patient information meet applicable HIPAA requirements before information is shared.
  • Request copies of the medical records, IZ, Invoices and corresponding claims.
  • Analyze information obtained to identify discrepancies and anomalies determining if services were properly documented and properly billed.
  • Document any findings resulting from the claim review and determine if a remedy is available to address the findings. If a remedy is appropriate, work with the client to implement remedy according to all applicable external requirements and internal policies.
  • Ensure necessary repayments are completed by the appropriate party for any identified payment discrepancies. Interprets and understands health insurance appeals and provider dispute resolution processes, applicable clinical guidelines, and health payer coverage policies to effectively prepare claim packages and procedures are followed.
  • Maintain current knowledge of operational and billing policies, practices, and references Responds to inquiries and/or reports of billing concerns, noncompliance with company policy and procedure taking the appropriate actions as required.
  • Complete knowledge of Stop-loss? Highdollar reimbursement
  • Review claims (paid, pending, and denied) for accuracy, appropriate application of benefits, authorization for services, contract interpretation, Division of Financial Responsibility (DOFR), and application/compliance with policies and procedures.
  • Research over and under-payment inquiries/appeals
  • Compile and maintain statistical data consistent
  • Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
  • Maintain departmental production and quality standards
  • Continuously sought opportunities to streamline workflows and implement process improvements within the claims department, resulting in increased efficiency and productivity levels.
  • Advanced Experience in Epic software

Front Office Supervisor

Providence Orthopaedics Tarzana
04.2020 - 10.2022
  • Embrace and provide a safe, comfortable, patient centered environment.
  • Understand, embraces and instill Providence Medical Institute, Vision and Values.
  • Receive, greet and direct patients, visitors and responds to inquiries with tact and courtesy.
  • Enter new patients and existing patient's data into the computer.
  • Maintain patients' medical records and verifies accuracy.
  • Verify patients' insurance, collects co-payment and provides receipt for patient. Inpatient and outpatient services.
  • Order office supplies and necessities (paper towels, soap, etc.) and maintains appropriate level of inventory.
  • Deposit cash receipts.
  • Prepare, route, and verify referrals appropriately.
  • Prepare Medical Records to be scanned in system.
  • Prepare and sorts outgoing/incoming mail and distributes appropriately.
  • Contact appropriate personnel for computer and building maintenance.
  • Operate standard office equipment such as a personal computer, calculator, fax and copier with efficiency.
  • Maintain Clinic standard policies and procedures related to infection control, fire and safety, human resources, and clinic procedures.
  • Schedule routine and new patient appointments and generates a daily list as applicable.
  • Answer/resolve billing inquiries on accounts in a professional and courteous manner as applicable.
  • Answer the telephone, take messages and/or refer calls as appropriate, and as applicable.
  • Answer Surgery related questions
  • Medical clearance for all 10 Orthopaedics Physicians
  • Epic program experience

Medical Billing Manager

Center for Orthopaedics Specialists
09.2014 - 04.2020
  • Providence Hospital affiliation Practice
  • Constant correspondence with clients, claimants, insurance companies, Bill review Status, vendors in regards to Inpatient, ER and outpatient billing claims filed on UB04/HCFA-1500
  • Resolve billing claims by reviewing EOB, EOR denial, analyzing, re-billing for underpayments or discrepancies, sending appeal letters, correspondence to denials, and processing reimbursements for Inpatient and outpatient billing.
  • Worked with various city duties in getting approvals in processing WCOMP claims
  • Processes routine claims with multiple product lines, to determine type and amounts of benefits payable to accordance to company policy, procedures, contacts and guidelines
  • Generating statement for patient copay/deductibles responsibilities
  • Verify information from claimant, physicians, and insurance carrier, maintain accurate records and handles administrative responsibilities associated with processing and payment of claims
  • Posting insurance payments on patient accounts
  • Performed a verify of complex administrative and financial support duties
  • Familiarized with New ICD-10 and experience in ICD-9 diagnoses
  • Resolving all Billing issues to the best of my knowledge for both Inpatient and Outpatient service
  • Eligibility verification for both In and Out of Networks based on facility contract
  • Excellent phone Etiquette to provide proper service for our treated patients
  • EcIncal works (ECW) program experience

Medical Collector/ Biller Supervisor

Specialty Surgical Center of Arcadia
05.2010 - 09.2014
  • Setting goals and objectives
  • Delegating
  • Providing assistance and support
  • Payroll
  • Providing a climate for motivation
  • Creating a supportive working relationship
  • Emphasizing continuing development
  • Providing opportunities for future growth and advancement
  • Constant correspondence with clients, claimants, insurance companies, Bill review Status, vendors in regards to outpatient billing claims filed on UB04/HCFA-1500
  • Handled 150-200 files weekly within WCOMP,HMO,PPO,POS worker compensation line of business, maintain low credit balance, create daily financial reports, calculate contract rate fees
  • Resolve billing claims by reviewing EOB,EOR denials, analyzing, re-billing for underpayments or discrepancies, sending appeal letters, corresponding to denials, processing reimbursements
  • Verify information from claimant, physicians, and insurance carrier, maintain accurate records and handles administrative responsibilities associated with processing and payment of claims
  • Posting insurance payments on patient accounts.
  • Generating statement for patient copay/deductible responsibilities
  • Performed a verify of complex administrative and financial support duties
  • Worked with various city duties in getting approvals in processing WCOMP claims

Preschool Teacher

Lake Ave Church
06.2003 - 05.2010
  • Preparing daily class agenda
  • Lesson planning for the entire school year
  • Early childhood intervention
  • Individual lesson plans
  • Student motivation
  • Used fun games and activates to increase children with their vocabulary and communication skills

Office Manager

Dr. Ray Iskander OB/GYN Gynecologist Office
03.2000 - 06.2003
  • Customer service and heavy telephone correspondence
  • Posting insurance payments on patient accounts
  • Generating statement for patient copay/deductibles responsibilities
  • Verify information from claimant, physicians, and insurance carrier, maintain accurate records and handles administrative responsibilities associated with processing and payment of claims
  • Scheduling patient appointments
  • Accounts payable and receivable
  • Insurance contract follow up.
  • Eligibility verification

Education

High School Diploma -

Glendale High School
Glendale, CA
06-1999

Business and Accounting administration courses

Devry University
West Hills, CA
01-2002

Associate of Arts - General Units And / Child Development Units

Pasadena City College
Pasadena, CA
01.2004

Skills

  • Excellent leadership skills
  • Working knowledge of HIPPA and physician claims, managed care industry and coordination of benefits
  • Great ability to read and interpret benefit contracts and standard reference materials such as CPT, ICD-10 HCPCS
  • Strong knowledge of Lotus Notes, Microsoft Office and hospital systems such as Surgical Source system
  • Excellent customers service, communication, organization and interpersonal skills
  • Able to work independently & in group settings, good math, typing (50wpm) & 10key skills
  • Bilingual (fluent in English, Armenian)
  • Outstanding ability to manage large workloads, with attention to details, timeliness, and guidelines without compromising accuracy and high profession standards
  • Setting goals and objectives
  • Excellent communication skills
  • Skilled in Epic, ECW and Source Medical programs

Languages

Armenian
Native or Bilingual

Timeline

Senior Revenue Claims Analyst

City of Hope National Medical Center
10.2022 - Current

Front Office Supervisor

Providence Orthopaedics Tarzana
04.2020 - 10.2022

Medical Billing Manager

Center for Orthopaedics Specialists
09.2014 - 04.2020

Medical Collector/ Biller Supervisor

Specialty Surgical Center of Arcadia
05.2010 - 09.2014

Preschool Teacher

Lake Ave Church
06.2003 - 05.2010

Office Manager

Dr. Ray Iskander OB/GYN Gynecologist Office
03.2000 - 06.2003

High School Diploma -

Glendale High School

Business and Accounting administration courses

Devry University

Associate of Arts - General Units And / Child Development Units

Pasadena City College

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Yvette Vartanian