Resolution Analyst Resume Samples
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Resolution Analyst Resume Samples
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EK
E Kerluke
Ephraim
Kerluke
87701 Prohaska Meadow
Phoenix
AZ
+1 (555) 831 7483
87701 Prohaska Meadow
Phoenix
AZ
Phone
p
+1 (555) 831 7483
Experience
Experience
Philadelphia, PA
Resolution Analyst
Philadelphia, PA
Purdy LLC
Philadelphia, PA
Resolution Analyst
- Perform daily quality review of grievances submitted by caseworkers
- Providing daily feedback to caseworkers
- Conduct in depth research on member issues in order to provide quality resolution
- Multitask and work with up to 15 various computer applications
- Work independently in a fast-paced, dynamic and regulated team environment
- Multitasking and working with up to 15 various computer applications
- Conducting in depth research on member issues in order to provide quality resolutions
Boston, MA
Claims Resolution Analyst
Boston, MA
Hilll, Swaniawski and Gutmann
Boston, MA
Claims Resolution Analyst
- Accepts change as a normal part of doing business, maintains a positive attitude and exhibiting constructive work behaviors during periods of transition
- Uses systems, reports, and Standard Operating Procedures to work assigned claim steps and gather supporting claims information
- Works to decrease defects and achieve automation (aka Ready to Clear) targets by keeping Standard Operating Procedures updated
- Meets work and attendance expectation; informs others in advance when commitments cannot be fulfilled
- Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues
- Performs user acceptance testing to ensure new contracts are loaded correctly and system modifications are accurate
- Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing
present
Dallas, TX
Senior Recovery / Resolution Analyst
Dallas, TX
Swift-Gusikowski
present
Dallas, TX
Senior Recovery / Resolution Analyst
present
- Participates in provider / client / network meetings, which may include provider education through written communication
- Track vendor and internal operational team quality of work and performing audits
- Work collaboratively with COB SMEs, operational teams and management, health plan representatives, and other external and internal partners
- Work with internal operational teams (COB Ops) to manage cost avoidance loading and validation process
- Generally, work is self-directed and not prescribed
- Identifies over billing patterns and trends, waste and error, and recommends providers to be flagged for review
- Maintains and manages daily case review assignments, with a high emphasis on quality
Education
Education
Bachelor’s Degree in Liberal Arts
Bachelor’s Degree in Liberal Arts
University of Georgia
Bachelor’s Degree in Liberal Arts
Skills
Skills
- Great communication skills to include leading discussion with ALL levels within an organization
- Proven ability to work in a team setting
- Ability to prioritize and manage multiple tasks
- Excellent oral and written communication skills and presentation skills
- This is a production environment
- Frequent speaking, listening, using a headset, sitting, use of hands/fingers across keyboard and use of mouse, and working at a computer
- Analytic Problem Solving Skills
- Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
- Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
- Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
15 Resolution Analyst resume templates
Read our complete resume writing guides
1
Early Dispute Resolution Analyst Resume Examples & Samples
- Investigate and draft responses to oral and written customer sales practice complaints received by brokerage offices nationwide
- Draft necessary regulatory filings related to sales practice complaints
- Draft responses to regulatory inquiries stemming from customer complaints
- Work with branch offices on non-complaint matters that need review and settlement
- Candidates should have a 4-year college degree with outstanding academic credentials,
- Must have excellent written and verbal communication skills, attention to detail and strong time management skills
- Must have the ability to interact in a mature and professional manner with a variety of individuals
- Must have general knowledge of investing and markets and the ability to research investment related allegations
- Must exhibit excellent judgment, initiative and adherence to deadlines
- Must be able to interact with Firm clients and the willingness to receive and apply feedback on work product from supervisor(s)
2
Exception Management & Resolution Analyst Resume Examples & Samples
- Investigation and resolution of all trade and position breaks across Cleared Derivative Markets
- Investigation and resolution of all Front office / Back office breaks across Cleared Derivative markets
- Assisting client service teams globally with the resolution of client queries
- Completion of daily control account tasks
3
Disputes Resolution Analyst Resume Examples & Samples
- Handle customer calls in a professional, courteous manner utliizing discretion while balancing the risk between the Bank and the customer
- Analyze and utilize all bank records available, including but not limited to Mobius, Fifth Third Direct, ACE, Raft, Canopy, Total Systems 1, Total Systems 2, PRISM, DVR, ACAPS, PEP+, Check Image Archive, Resolve Check, and the case management system tofacilitate a comprehensive review of unauthorized customer financial transactions
- Request documentation of transactions from other departments, customers, merchants, and other financial institutions to formulate appropriate risk decisions
- Assure that regulatory timeframes as well as internal Service Level Agreements are met to avoid compliance violations, which include, but are not limited to issuance of credit, reversal of fees, interest reimbursement, mailing appropriate notificationletters to customers, case closure timeframes, etc
- Coordinate the investigation of any fraud/disputes issues with the appropriate fraud/dispute investigative unit or agency, as appropriate
- Interact with the Internal departments to identify trends/issues and offer recommendations for improvements to policy and procedures, as applicable
- Ensure that departmental procedures as well as regulations are met
- Refers exception cases to Escalations, Supervisor or Manager when they are outside of pre-established guidelines
- Minimum of 1 year call center, banking operations or customer service
- Ability to research and make appropriate decisions regarding complex cases
- Ability to maintain professionalism in stressful and confrontational situations
- Strong PC knowledge, including MS Office, Word, and Excel, PowerPoint
4
Centralized Atm Review & Resolution Analyst Consumer Banking Resume Examples & Samples
- Must be proficient in MS Office applications, particularly MS Excel
- Demonstrated critical thinking skills and problem solving skills are a must
- SAP experience is helpful
5
Centralized ATM Review & Resolution Analyst Resume Examples & Samples
- Four or more years banking experience in a research oriented position with potential customer impact
- Extensive understanding of bank accounting and ability to perform higher math functions is required
- Must be able to use department policies and procedures to prioritize resolution of open items. Must also be able to look beyond the obvious to resolve more difficult exception items
- Good written and verbal communication skills are a must. Candidate will spend at least 25% of his/her time communicating with others to assist in resolving exception items or in detailing the resolution of exception items
6
Invoice Client Resolution Analyst Resume Examples & Samples
- Bachelor’s degree (Business, Marketing, or Finance majors preferred)
- Strong analytical skills to enable evaluation of trends in billing behavior and possess the necessary communication skills to present these to management
- Advance skills in MS Excel, Visio, MS Word, MS Access and PowerPoint skills
- Ability to work in a flexible work schedule, potentially outside of the 9-5 business hours
- Ability to understand unique process requirements, interdependencies, and eloquently explain them
- Possess highly detailed planning, organization, and solid execution capability
- Ability to multi-task, along with working in a fast pace environment
- Excellent organizational, analytical, problem solving and interpersonal skills
- Exercise sound judgment
- Effectively communicate with all levels of the organization
7
Disputes Resolution Analyst Resume Examples & Samples
- Handle multiple types for disputes including but not limited to UCC, Reg E and Reg Z disputes
- Prioritize task appropriately without jeopardizing customer service
- Initiate and participate in special projects including system and staff analysis to improve the day-to-day operation of the group
- May assume additional responsibilities as necessary
- High School diploma required or equivalent
- Minimum of 2 years of call center, banking operations or customer service
- Knowledge of regulatory requirements related to fraud detection/investigation, including Suspicious ActivityReports, USA PATRIOT Act, OFAC, Reg. CC, Reg E, Reg Z and FACTA, Visa/Mastercard Chargeback rules
8
Collections Asset Resolution Analyst Resume Examples & Samples
- Handle inbound/outbound calls related to all Asset Resolution processes through professional and effective communication; balance business objectives and customer satisfaction to avoid escalation
- Adhere to all legal regulations and established departmental procedures to ensure state requirements and compliance standards are achieved
- Ensure timely execution of all processes and communications to both internal and external customers
- Process accounts for closure following vehicle repossession within 24-48 hours
- Maintain appropriate filing standards
- Resolve total loss accounts by maintaining appropriate follow up and communication with the insurance company and/or the customer
- Review, audit and forward invoices from vendors for proper payment
- Maintain accurate impound records, making follow up calls and decisions around lien sales, when necessary
- Assist team members with workload beyond assigned daily duties when able, and demonstrate conduct that supports a collaborative team environment
- Communicate professionally with various corporate and field staff on matters of mutual interest and concern
- Suggest opportunities for process improvement and/or alignment to leadership
- Minimum of two years collections experience
- Three or more years automotive finance experience
9
Complaint Resolution Analyst Resume Examples & Samples
- Review, investigate and respond to complex sales practice customer complaints, including complaints from regulators
- Investigate complex customer complaints including conducting interviews of financial advisors, supervisors, and customers
- Provide guidance and recommendations to management on available courses of action with respect to resolution of customer complaints and relevant regulations
- Evaluate risk and resolve customer complaints appropriately, including settlements of upwards of $200,000
- Ensure that required regulatory filings are prepared and transmitted to the firm's Registration Department for filing with FINRA in a timely manner
- Assist the firm's Legal Department with the preparation of discovery documents related to pending arbitrations and/or litigations involving customer complaints. Identify sales practices concerns and refer matters to the firm's Risk, Examination and/or Surveillance Groups for possible corrective and/or disciplinary action
- Bachelor's degree and 5-7 years of progressively responsible compliance/securities industry experience required
- Experience in complaint handling and dealing with regulators is preferred
- Excellent writing skills are mandatory
- Series 7, 66, 9/10 or 24 registration is desirable
- Series 53, 4; Life and Disability licensing is desirable
- Knowledge of concepts, products, practices and compliance techniques for the financial services industry preferred
- Ability to understand complex legal and regulatory issues, FINRA rules and regulations required
- Understanding of methodologies for researching and analyzing compliance issues required
- Understanding of reporting requirements of various regulatory agencies required
- Advanced MS office skills including Word, Excel and PowerPoint preferred. Ability to learn proprietary software
10
Complaint Resolution Analyst Resume Examples & Samples
- Review, investigate and respond to customer complaints
- Assist the firm's Legal Department with the preparation of discovery documents related to pending arbitrations and/or litigations involving customer complaints. . Conduct interviews of Financial Advisors or other firm employees in connection with the investigation of customer complaints
- Provide recommendations to management on available courses of action with respect to customer complaints
- Identify widespread operational concerns and refer matters to the firm's Risk, Examination and/or Surveillance Groups for possible corrective action
- Bachelor's degree and 3-5 years of progressively responsible compliance/securities industry experience required
- Experience in complaint handling and dealing with regulators is preferred. Excellent writing skills are mandatory
11
Centralized ATM Review & Resolution Analyst Resume Examples & Samples
- High School diploma or equivalent. Some college preferred
- Demonstrated critical thinking skills and problem solving skills and ability to deliver results under urgent circumstances (when necessary) are a must
- Exceed Expectations
- Must be able to use department policies and procedures to prioritize resolution of open items
12
Claims Resolution Analyst Senior Resume Examples & Samples
- Fosters and maintains provider relationships during the claims resolution process
- Manages and resolves issues with provider data management, configuration, call center , claims and appeals, cost containment and other corporate functional areas
- Provide claims project leadership. Oversees the completion and accuracy of claims related projects
- Coordinate the identification and resolution of root causes involving configuration, claims and/or contracting activities. Identifies and monitors trends
- Partners and supports leadership across the health plan on assigned projects ensuring company goals are met
- Requires a BA/BS; 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience, which would provide an equivalent background
13
Identity Resolution Analyst Resume Examples & Samples
- Previous watchlisting experience
- Experience with identify resolution
- Advanced writing, editing, and listening skills to effectively convey multifaceted ideas
14
Title Resolution Analyst Resume Examples & Samples
- Review of title commitments and title searches to identify and validate titles issues / liens
- Identify best course of action with the anticipated timelines required to cure the file
- Escalate opportunities to mitigate losses or otherwise settle
- Responsible to obtain, review and clear all title requirements including: Condo or Homeowners Association Statements and Entity Documents (LLC’s/Corporations)
- Preparation of standard Stewart closing documents
- Probate Documents, Trusts
- Correspond with vendors to obtain necessary documentation to assist with title clearance issues
- Maintain expected production levels and delivery standards on a daily basis
15
Centralized ATM Review & Resolution Analyst nd Shift Resume Examples & Samples
- Four or more years banking experience in a research oriented position with potential customer impact is ideal
- Must be able to follow a defined process to complete the daily work and make suggestions to improve the process, as necessary
- Demonstrate behaviors consistent with the 5 Keys to a Great Customer's Experience
- Always Be Courteous and Professional
- Build Lasting Relationships
- Do the Right Thing
- Own Customer Issues Start-to-Finish
- Must also be able to look beyond the obvious to resolve more difficult exception items
16
Disputes Resolution Analyst Resume Examples & Samples
- Knowledgeable of VISA charge-back rules
- Must have knowledge and use of office equipment (Excel, Word, First Data operating platform.)
- Must have exceptional phone skills
- Must have knowledge of the Fair Credit Reporting Act, Reg E., Reg Z. policies and procedures
- Demonstrates ability to be flexible and organized
- Demonstrates good time management skills and ability to self-motivate
- Demonstrates a positive attitude to deal effectively and professionally with customers
- Demonstrates good decision-making/problem solving ability
- Demonstrates ability to work with minimal direct supervision
- Must be able to key (30-35 wpm)
- Knowledgeable of Bank's Mainframe and RDS systems
- Knowledgeable of First Track and First Disputes case management systems
- Knowledgeable in Hogan
- Knowledgeable of LexisNexis
- Knowledgeable of Mosaic
- Knowledgeable of Archer
- Knowledgeable of the TSYS platform
- Knowledgeable in ChexSystems-eFunds
- Knowledgeable in Check Vision
- Knowledgeable of MasterCard Connect
- Knowledgeable of VISA Resolve Online (Prepaid)
- Knowledgeable of VISA Online
- Knowledgeable of Star Station
17
Recovery / Resolution Analyst Resume Examples & Samples
- Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Investigate and pursue recoveries and payables on subrogation claims and file management
- 1+ year of customer service experience analyzing and solving customer problems
- Intermediate level of Microsoft Excel (developing and comparing spreadsheets as well as v-look ups)
18
Claims Resolution Analyst, Iowa Preferred Resume Examples & Samples
- Requires a BA/BS; 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience, which would provide an equivalent background
- FACETS experience preferred
- Experience with insurance claims research, resolution, overpayment, recovery, investigation and/or analysis to resolution required
19
AP Resolution Analyst Resume Examples & Samples
- Accounts Payable Processing 2-3 years
- Strong Written and verbal communication skills 2-3 years
- Excel Intermediate 1-2 years
- Customer Service 1 year
- Outlook 1 year
- Word 1 year
- Accurate/Efficient processing 2-3 years
- SAP or Oracle 2-3 years
- Critical escalation resolution/audit 1 year
20
Claims Resolution Analyst Resume Examples & Samples
- Investigates and facilitates the resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and health plans and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing
- Identifies the interdependencies of the resolution of claims errors on other activities within operations
- Assists in the reviews of state or federal complaints related to claims
- Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines
21
Claims Resolution Analyst Senior Resume Examples & Samples
- Excellent report analysis and report writing skills - able to provide results written and orally in a clear and concise manner to stakeholders at all levels within the organization
- Computer skills: MS Office, with an emphasis on Excel skills
- Experience with complex, high dollar claims issues preferred
- Knowledge of ICD-10 coding preferred
22
Title Resolution Analyst Resume Examples & Samples
- Good written communication and presentation skills
- Strong customer service orientation and focus
- Completion of a high school diploma
- Minimum of one year of industry experience as a real estate escrow officer, closer or processor. Possessing a title license is a plus
23
SSC Overpayment Resolution Analyst Resume Examples & Samples
- Processes refunds to patient and insurance accounts, maintaining appropriate knowledge and understanding of all Managed Care Contracts, Federal payers and CHS policies
- Work insurance overpayments request letters received via BARRT, faxes and telephone requests
- Prepares daily Credit Balance reports
- Analyzes issues causing credit balances
- Submit adjustments to reverse overstated contractuals or to transfer patient overpayments to another account
- Completes refund request with appropriate backup documentation
- Performs the quarterly Medicare Credit Balance review and Escheat Report
- Pulls EOB's and required documentation for audits
- Ensures compliance procedure for prompt recording of all refunds
- Coordinates any refund issues with Reimbursement Manager/Supervisor and Reimbursement Specialists as needed
- Assists with month end reporting
- Ability to prioritize work, ability to work independently
- Required proficiency in Microsoft Office Tools
- High School Graduate minimum education requirement
- Preferred 1 experience in a hospital business office department
24
Senior Recovery / Resolution Analyst Resume Examples & Samples
- Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
- Undergraduate degree is strongly preferred in Business, Statistics, Computer Science, Accounting or related field
- Strong interpersonal skills and ability to interact with multiple departments and management
- An undergraduate degree or higher
- Experience in behavioral health claims
25
Claims Resolution Analyst Resume Examples & Samples
- Demonstrates development of positive relationships with peers
- Understand their functional area business processes
- Support Business Case Development
26
Resolution Analyst Resume Examples & Samples
- Conduct in depth research on member issues in order to provide quality resolution
- Creatively construct written communication to members
- Multitask and work with up to 15 various computer applications
- Assess issues related to the pharmacy within Medicare Part D guidelines and resolve any issue with an appropriate plan and outcome
- Document the issue and resolution in the database, while adhering to the strict turnaround time established by the Center for Medicare and Medicaid Services (CMS)
- Share the outcome with the customer through verbal and/or written correspondence
- Work independently in a fast-paced, dynamic and regulated team environment
- Partner with internal business units and external partners when you are navigating and researching issues
- Acquire and maintain basic knowledge of relevant and changing Med D policies and procedures
27
Resolution Analyst Resume Examples & Samples
- Meeting or exceeding CMS imposed timelines Interacting directly with the client and CMS to resolve grievances
- Providing member feedback in an effort to improve member experience
- Providing daily feedback to caseworkers
- Handling highly raised cases for research and resolution
- Following CMS and internal quality standards
- Participating in all CMS and mock audit prep and post activities
- Contributing to additional projects as needed
28
Channel Resolution Analyst Resume Examples & Samples
- Uses financial statements to independently determine the financial condition of customers and decides credit limit recommendations for medium monetary value customers
- First level university degree with a focus in business or economics; MBA preferred
- Typically 4-6 years of experience in credit internally or in banking; or in collection
- Solid understanding of risk mitigation tools
- Advanced understanding of collection processes, financial principles and channel partners
29
Resolution Analyst Resume Examples & Samples
- Meet or exceed CMS imposed timelines Interact directly with the client and CMS to resolve grievances
- Outreach to internal business partners to provide member feedback with the goal of improving the member experience Provide daily feedback to caseworkers
- Perform daily quality review of grievances submitted by caseworkers
- Handle highly escalated cases for research and resolution
- Comply with CMS and internal quality standards
- Participate in all CMS and mock audit prep and post activities
- Support client specific needs Contribute to additional projects as needed
30
Problem Resolution Analyst Resume Examples & Samples
- Do analysis and findings regarding internal Customer Experience Operation and actively drive close loop feedback to operation/support team up to problem resolution
- Conduct statistical/quantitative analyses to aid understanding of root causes
- Follow-up with business and vertical owners to ensure improvement initiatives are end-to-end and action log progress is on schedule
- Control and monitor impact assessment from user experience perspective to ensure the system and process in CRM environment could performs and operate properly-delivered
- Defined business processes, guidance and documentation related to customer experience system support and case resolution process
- Provide feedback on internalizing and implementing key learning into process documentation
- Create and define user experience testing scenario of GC and GB and competitors to provide insights related to Pax and Dax apps
- Experience and a track record in Customer Experience system, process and operations
- Strong relationship-building skills and experience working closely across department with executives
- Bachelor’s degree with strong academic performance; M.B.A. or other relevant advanced degree is a plus
- Action-oriented, entrepreneurial, flexible, and innovative approach to operational management
- Analytic and decisive decision maker with the ability to prioritize and communicate key objectives and tactics necessary to achieve organizational goals
- Strong written and verbal communication skills; a persuasive and passionate communicator with good public speaking skills
- Excellent communication skills with the ability to distil complex issues and detailed analysis into simple, structured frameworks with concrete action plans
31
Title Resolution Analyst Resume Examples & Samples
- Review of trusts, divorces, probate, land contracts and other types of conveyance instruments for compliance in
- The issuance of title insurance
- Responsible to obtain and review a survey for use in clearing exceptions to title and affording certain affirmative
- Coverages to lender customers
- Minimum Two (2) years of industry experience as a real estate escrow officer, closer or processor. Possessing a title license is a plus
32
Claims Resolution Analyst, Seattle Resume Examples & Samples
- Assists in the reviews of state or federal complaints related to claims. Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines
- Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved
- Performs claims and trend analysis, ensures supporting documentation is accurate and obtains necessary approvals to close out claims issues
- Recommends new or modified processes and procedures to reduce claims errors, taking into consideration business requirements and system limitations
- Performs user acceptance testing to ensure new contracts are loaded correctly and system modifications are accurate
- Education Required: Bachelors degree, or equivalent related experience
- Three years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry preferred
- 5+ years of claims research and/or issue resolution preferred
- Knowledge of benefit/pricing configuration preferred
- Facets experience a plus
- Experience with APG Pricing/Webstrat preferred
33
Claims Resolution Analyst Resume Examples & Samples
- Background must include a position where over 75% of your job was to research and analyze medical claims
- Knowledge of ICD 10 coding
- Excellent computer skills: MS Word, Outlook, Excel
- Experience in Medicaid/managed care preferred
34
Resolution Analyst Resume Examples & Samples
- Conducting in depth research on member issues in order to provide quality resolutions
- Creatively constructing written formal communication to members
- Cross functionally working with various departments to identify root cause analysis of Member issues
- Multitasking and working with up to 15 various computer applications
- Analyzing issues related to the pharmacy within Medicare Part D guidelines and resolving any issues with an appropriate plan and outcome
- Documenting the issue and resolutions in the database,while adhering to the strict turnaround times established by the Center for Medicare and Medicaid Services (CMS)
- Sharing the outcome with the customer through verbal and/or written correspondences
- Working independently in a fast-paced, dynamic and regulated team environment
- Partnering with internal business units and external partners when you are navigating and researching issues
- Acquiring and maintaining basic knowledge of relevant and changing Med D policies and procedures
35
Senior Recovery Resolution Analyst Resume Examples & Samples
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Clinical and/or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical
- Director/physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
- Performs clinical coverage review of post-service, pre-payment claims, which requires interpretation of state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information on claims with aberrant billing patterns
- Identifies aberrant billing patterns and trends, evidence of fraud, waste or abuse, and recommends providers to be flagged for review
- Participates in provider/client/network meetings, which may include provider education through written communication
- 2+ years of current CPT/HCPCS coding experience (entering codes, auditing etc.)
- Possess an unrestricted nursing license (RN/LVN/LPN) or are a current certified coder (CPC/CCS/RHIT etc.)
- Available to work overtime as business needs require
- Managed Care experience
- Investigational and/or Auditing experience
36
Senior Recovery / Resolution Analyst Resume Examples & Samples
- Conduct quality audits on COB/Hospice Medicare claims
- Examine and document business operations and procedures to ensure data integrity and process optimization
- Investigate, recover, and resolve COB and Hospice claims as well as recovery and resolution for Medicare business
- Investigate payables on subrogation claims and file management
- Investigate recovery on claims
- Drive Coordination of Benefit (COB) business/regulatory requirements at a plan level
- Heavy focus on new business implementation and system migrations
- Monitor program monthly financial status by comparing and analyzing forecast saving against actual results to ensure financial goals are met
- Seek out project opportunities to drive the identification of new COB information and the improvement of COB processes
- Support internal/external vendor activity by providing Subject Matter Experts (SME)
- Track vendor and state file delivers to ensure other coverage information is loaded timely
- Perform vendor/state file reconciliation and quality audits
- Track vendor and internal operational team quality of work and performing audits
- Work with internal operational teams (COB Ops) to manage cost avoidance loading and validation process
- Research escalated COB issues and concerns, to identify root causes of problems or explain misinterpretations of COB outcomes
- Represent department in IT and business initiatives
- Represent department in internal/external audits
- Research COB Encounter rejects
- Research cost avoidance reconciliation issues
- 1+ years of experience working with medical claims platforms
- 2+ years of experience with claims auditing and researching claims information
- 1+ years of experience analyzing data and identify cost saving opportunities
- Knowledge of claims processing systems and guidelines/processes
- Experience with Microsoft Excel (to include data entry into existing spreadsheets and the ability to manipulate said data)
37
Business Resolution Analyst Resume Examples & Samples
- Intake escalated customer issues from various internal teams or external sources and see them through to resolution
- Interpret contracts and transaction documents to determine financial and operational requirements
- Analyze overall performance of an asset using both qualitative assessment and detailed quantitative techniques
- Investigate and summarize the history of each case, determining the root cause of any error or complaint, as well as any contributory factors
- Develop expertise on, and determine viable solutions, for assets subject to contract obligation disputes with consideration for the customer experience, as well as financial and operational implications
- Recommend, develop, implement and manage appropriate courses of action taking into account the best interests of the company, the investor, and the customer
- Manage and interface with key internal and external stakeholders to resolve projects effectively and promptly, ensuring multiple departments adhere to deadlines
- Drive other projects as required or as business needs change
- Bachelor’s degree from an academically outstanding institution in a relevant field required
- 2 to 5 years of experience in a relevant project management, analytical, or customer-facing role preferred
- Strong analytical, investigative and problem solving skills with keen attention to detail
- Ability to independantly prioritize and multi-task, with the flexibility to adapt quickly to change
- Strong project management skills with the ability to synthesize relevant details within complex situations
- Strong communicator who is able to combine tact with clarity
- Expertise MS Office, with ability to learn new software/tools with minimal supervision
38
Resolution Analyst Resume Examples & Samples
- Handle highly escalated cases for research and resolution Comply with CMS and internal quality standards
- Support client specific needs
- Contribute to additional projects as needed
39
Customer Resolution Analyst Resume Examples & Samples
- Deliver timely and accurate research, creating, managing and maintaining appropriate records in Salesforce.com
- Evaluate, manage, and resolve inbound issue resolution requests from Sales, Customer Relations, Key Client Services and other internal and external parties, assigned to the Resolution Team within the designated response time
- Issue a resolution based on analysis of facts gathered from customer, system of record, billing systems, and other internal contacts
- Communicate proposed resolution with customer and follow up to insure recommended course of action has been followed
- Interact with customers regularly to seek clarification, address issues, provide progress updates and review actions taken for resolution
- Review and analyze reporting for internal and external parties to manage financial exposure, prior to processing transactions
- Extract relevant data from various systems
- Build and maintain effective working relationships with internal functional teams and executive managers
- Influence and document the resolution of the issue from appropriate stakeholders, as necessary
- Monitor, manage, and respond to external requests for issue resolution within established timelines, including but not limited to ERCOT Market Track, Public Utility Commissions, and third party vendors
- Facilitate cross functional meetings as needed to address customer impacting issues and processes
- Develop and manage new departmental procedures to create efficiencies and streamline processes with a focus on improving the customer experience
- Build knowledge of various products and other company-wide information over time
- Perform other functions as necessary or as assigned
40
Senior Recovery / Resolution Analyst Resume Examples & Samples
- Investigate, audit, and resolve all types of Medicaid claims as well as recovery and resolution for government payers
- Generally, work is self-directed and not prescribed
- 2+ years of experience auditing and monitoring
- Experience with Microsoft Excel including data entry, sorting, creating / modifying spreadsheets, VLOOKUP, and formulas
- Up to 25% travel required
- Multiple coding and auditing certifications preferred
- 1+ year of experience analyzing data and identifying cost saving opportunities
- Microsoft Access (create and modify queries and reports)
- Experience working with state Medicaid programs
- Knowledge of claims processing systems (general knowledge in how claims are processed) and guidelines / processes
41
Resolution Analyst Resume Examples & Samples
- High School Diploma or General Education Degree (GED), or any combination of education and experience which would provide an equivalent background. Bachelor’s Degree preferred
- 6 months to 1 year of LTL rating or rate auditing experience preferred
- Strong analytical, root cause analysis and problem solving skills
- Must be familiar with MS Office programs to include Word, Access, and a proficiency in Excel
- Excellent customer service skills internally and externally
- Math skill proficiency and basic algebra highly preferred
- Must be able to interact well with others
- Responds well to questions; Ability to read, interpret and comply with written information and documents such as safety rules, operations / procedure manuals and maintenance instructions with a high comprehension and concentration level to include the ability to meet deadlines
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Claims Resolution Analyst Resume Examples & Samples
- Provide project team leadership
- Coordinate the identification and resolution of root causes involving configuration, claims and/or contracting activities
- Creating Microsoft Access Database
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Senior Recovery / Resolution Analyst Resume Examples & Samples
- Investigates, reviews, and provides clinical and / or coding expertise in the application of medical and reimbursement policies within the claim adjudication process through file review. This could include Medical Director / physician consultations, interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies and consideration of relevant clinical information
- Performs clinical coverage review of post - service, pre - payment claims, which requires interpretation of state and federal mandates, applicable benefit language, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims with over billing patterns
- Performs clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing
- Identifies over billing patterns and trends, waste and error, and recommends providers to be flagged for review
- Certified Coder AHIMA or AAPC Certified, CPC, CCS, RHIT, CPMA, RHIA OR RN, LPN with unrestricted license
- 2+ years of experience as a Certified Coder AHIMA or AAPC Certified, CPC, CCS, RHIT, CPMA, RHIA with 2+ years of CPT / HCPCS / ICD - 10 coding experience with knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines OR 2+ years of RN, LPN current experience with an unrestricted license with 2+ years of CPT / HCPCS / ICD-10 coding experience with knowledge of health insurance business, including knowledge of industry terminology, and regulatory guidelines
- Analytic Problem Solving Skills
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Dispute Resolution Analyst Resume Examples & Samples
- Evaluate, research and monitor disputed items with internal and external customers within regional and cross-business unit customer accounts
- Monitor and run appropriate SAP reports to monitor Accounts Receivable disputes
- Corrects errors, including misapplied payments, reversed late charges and over payments
- Document conversations, e-mails and other communications. Organize documentation as to facilitate follow-up efforts. Initiate appropriate follow-up action on mail returned as undeliverable
- Perform follow-up procedures, as needed, with customers and accounts review
- Maintain quality relationships with account managers and area sales managers. These relationships can be critical with collection efforts. Involve regional managers when possible and keep them informed of issues at all times
- Act as the escalation along with Division management for problem solving or dispute resolution
- Work with the Data Integrity and Customer Master group to ensure accuracy of customer records and files
- Work closely with Billing, Cash Application, Collections, Sales and Tax departments to work resolving disputes timely
- Work with branch personnel, sales, and cylinder control to more effectively administer invoice error rates at or below regional and corporate targets
- Follow policies and guidelines related to billing and dispute resolution as they relate to Credit and Collections and Cash Application
- Communicate with both internal and external customers via phone, fax, email and letter to resolve issues; focusing on root cause analysis in an effort to eliminate and solve habitual customer issues
- Bachelor’s degree from a four-year college or university in accounting, finance, marketing or related field and three years of relevant experience, or equivalent combination of experience and/or training and education
- Advanced knowledge of Microsoft Office applications (Word, Excel, PowerPoint, and Outlook)
- Ability to write routine business reports and business correspondence in English
- Ability to effectively present information and respond to questions from employees and/or customers
- Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals using the English language
- Ability to compute rate, ratio, and percentages
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Resolution Analyst Resume Examples & Samples
- High School Diploma or General Educational Degree (GED), or any combination of education and experience, which would provide an equivalent background; undergraduate degree in Business or technical discipline desired
- Minimum of 1 years of customer service or sales preferred
- Experience in LTL including customer facing roles, rating experience, customer service, sales, revenue accounting, collections or problem solving roles preferred
- Must be familiar with MS Office programs to include Word, Access, and Excel; proficiency in SQL tools a plus
- Knowledge of AS400, LTL carrier operations, and pricing contracts desired
- Strong written, verbal and listening communication skills preferred
- Must be self-directed and possess strong organizational and time management skills
- Must be motivated and possess good research and problem solving qualities
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Claims Resolution Analyst Resume Examples & Samples
- Processes escalated claims, assesses the reason for the escalation, and provides resolution in priority order as directed by the Supervisor
- Searches for and links invoices, contracts, and Proof of Performance to claims as needed
- Uses systems, reports, and Standard Operating Procedures to work assigned claim steps and gather supporting claims information
- Processes invalid claims in accordance with set policies and guidelines
- Corrects and resolves claims ‘clean passed’ in error
- Researches validation issues and recommends appropriate solutions
- Reviews claims dashboard for actionable items on a frequent basis
- Meets or exceeds client and customer goals and requirements
- Makes the final decision on claims validity for escalated claims
- Sends compliant promotion package for clearing
- Contacts Sales, clients, customers, and management team for information as needed
- Proactively manages client and customer target dates to ensure claims are processed in a timely manner
- Communicates with clients and customers on a regular basis and provides value add solutions
- Escalates appropriately to the Supervisor when needed to get information or handle complex client and customer situations
- Understands types of escalations and uses problem solving and analytical skills to resolve them so they do not repeat
- Works to decrease defects and achieve automation (aka Ready to Clear) targets by keeping Standard Operating Procedures updated
- Monitors specific escalations data to determine the root cause of an escalation, where it originated and why it occurred
- Discusses defect issues with Sales, clients, customers, and management team and works with them to address the root cause
- Recognizes and provides solutions for operational obstacles that delay work completion on claims issues
- Four years claims experience preferred
- Food brokerage experience and/or clients’ experience in sales administration is strongly preferred
- Relationship management experience preferred
- Accepts accountability for job performance; proactively informs others when he/she encounters problems that may limit his/her ability to meet expectations
- Accepts change as a normal part of doing business, maintains a positive attitude and exhibiting constructive work behaviors during periods of transition
- Meets work and attendance expectation; informs others in advance when commitments cannot be fulfilled
- Actively supports organizational goals and values; aligns actions around organizational goals; gives priority to organizational needs and concerns when making decisions
- Takes a reasoned logical approach in making judgments and decisions, carefully reviews available facts and information before reaching any conclusions
- Identifies and gathers relevant information, consults the right people and asks the right questions in a given situation
- Demonstrates disciplined thinking that is clear, unbiased, analytical and informed by evidence
- Effectively communicate with others. Must be able to operate a calculator, computer, printer, fax machine, telephone, copier and shredder
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Senior Recovery / Resolution Analyst Resume Examples & Samples
- Process claims following CSI analyst comments
- Effectively handle their caseload, monitor mandated and internal turn-around time requirements
- Claims reconsideration and payment following instructions from other departments
- Follow Department Standards Operating Procedures and Corporate Policies
- Perform analysis of claim data as needed
- Continuous team training development and delivery
- Licensed Registered Nurse (RN), Licensed Practical Nurse (LPN) or Certified Coder
- 3+ years nursing / coding experience (surgical, hospital, clinic settings)
- CPT and ICD coding experience
- Experience working in a FWA / SIU or Fraud investigations role
- Experience working with Windows PC software - Microsoft Office: Microsoft Excel (creating / managing spreadsheets, formulas, and pivot tables), Microsoft Word (creating / and managing documents)
- Critical thinking, problem solving and analytical skills required
- Ability to prioritize and manage multiple tasks
- Proven ability to work in a team setting
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Appeals Resolution Analyst Resume Examples & Samples
- Assesses patient's clinical need against established guidelines and standards to ensure that the level of care and length of stay of the patient are medically appropriate for inpatient stay
- Evaluates the necessity, appropriateness and efficiency of medical services and procedures by inpatient facilities
- Performs review of medical records and prepares medical records for review by Medical Director as appropriate
- Investigates and resolves complicated appeals, coordinating with legal department as necessary and handles appeals concerning pre existing conditions
- Investigates and resolves high priority cases involving DOBI and Executive inquiries
- Prepares and presents appeals to Appeals Committee in accordance with criteria including coordination with independent URO
- Conducts presentations of appeals process to internal customers and works with Delegate and Vendor Oversight to assist vendors in establishing procedures to ensure their appeals process complies with requirements
- Plans appropriate allocation of resources to provide quality patient care in the most cost effective manner
- Documents accurately and comprehensively based on the standards of practice and current organization policies
- Interacts and communicates with facilities, physicians and or members/families, either telephonically and or on site striving for continuity and efficiency as the member is managed along the continuum of care
- Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes
- Performs special projects as assigned by management
- Demonstrates knowledge and understanding of the laws, regulations and policies that pertain to the organizational unit's business and conforms with these laws, regulations and policies in carrying out accountabilities of the job
- High School Diploma or GED required. Bachelor's degree from an accredited college or university in health care management field preferred
- Requires 2 years clinical experience
- Requires a minimum 1-year experience in the health care delivery system/industry
- Prefers working knowledge of principles of utilization management
- Prefers knowledge of health care contracts and benefit eligibility requirements
- Requires knowledge of hospital structures and payment systems
- Requires the ability to work in a high volume environment with moderate supervision
- Require the ability to apply an understanding of business fundamentals and administrative expense management of day-to-day decision-making
