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Work Background
DexianConfiguration Analyst
Sep. 2024United States
CongnizantConfiguration Analyst
May. 2013 - Sep. 2024Teaneck NJConfigured benefits per client specifications on the Facets platform. Configured CMS transmittals as they are published. Ensures Local Fee Schedules were loaded within specified timeframes. Utilized Miicrosoft SQL to load scripting into Facets. Interpreted and configured provider contracts. Configured both Medicare and Medicaid benefits and other Facets modules as required.
TMG HealthManager - Performance Reporting
Jan. 2010 - May. 2013- Detail analysis of enrollment/disenrollment & claims data to prepare monthly performance reports. -Analyze Medicare guidance for changes/impacts. - Audit enrollment records to CMS standards/specifications for accuracy and timeliness.
- Perform trend analysis to determine error trending.
TMG HealthInternal Audit, Supervisor
Apr. 2008 - Jan. 2010Dunmore, PA
TMG HealthFinancial Analyst
Jun. 2007 - Apr. 2008Dunmore, PA
TMG HealthCompliance Auditor
Apr. 2004 - Jun. 2007Scranton, Pennsylvania Area
TMG HealthClaims Analyst
Apr. 2001 - Apr. 2004Scranton, Pennsylvania Area
Blue Cross of Northeastern PennsylvaniaClaims Analyst II
Sep. 1998 - Apr. 2001Wilkes-Barre, PA- Paid/denied HCFA1500 claims for Medicare Advantage Plan.
- Reviewed and processed claim attachments.
- Entered provider authorizations for members. - Priced non-participating provider claims as per CMS fee schedules. - Responsible for complying with Federal and State Regulations.
Wilkes Barre General HospitalMedical Secretary II
Jan. 1997 - Sep. 1998Wilkes-Barre, PAI worked in the laboratory where I handled various types of specimens for the Medical & Pathology Technologists. This position required a lot of multi-tasking and a great regard for accuracy as we were responsible for ordering the appropriate lab tests for the appropriate patient.
- I ordered the lab tests, labeled the specimens for processing, utilized various types of lab equipment to prepare the specimens for testing. This including drawing off samples for cytology/pathology, and utilizing the centrifuge. - I released lab results to physicians when indicated, and made outreach phone calls to note critical lab results when needed.
Visiting Nurse AssociationAdmissions Clerk/Business Office
Oct. 1994 - Jan. 1997Wilkes-Barre, PA- Data entered and generated HCFA 485/487 Medicare forms within CMS timeframe and accuracy standards. - Billed various insurance companies with proper ICD-9 codes. - Reviewed charts for admission/discharge processing accuracy.
- Assisted in the generation of month end balance reporting.
Dallas Veterinary ClinicVet Technician/Receptionist
Jan. 1989 - Dec. 1991
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