Resolution Analyst Resume Sample
Kristin Kirlin
2218 Bednar Harbors,
New York,
NY
+1 (555) 898 0293
Work Experience
Senior Recovery / Resolution Analyst
10/2015
-
PRESENT
Boston, MA
- Meet or exceed CMS imposed timelines
- Interact directly with the client and CMS to resolve grievances
- Good organizational and people skills. The ability to work and navigate within a complex matrixed organization
- 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)
- Corrects and resolves claims ‘clean passed’ in error
- · Provides consumer data, e.g., identity and banking history, to member financial institutions in response to consumer’s application for banking services in accordance with rules and regulations, on behalf of ChexSystems, a Consumer Reporting Agency (CRA)
- Provides consumer data, e.g., identity and banking history, to member financial institutions in response to consumer’s application for banking services in accordance with rules and regulations, on behalf of ChexSystems, a Consumer Reporting Agency (CRA)
- Responds to requests for consumer reports received by internet, voice response unit, fax, or mail
- Provides consumer disclosures following appropriate procedures and rules based on personal identifiers provided by consumer and in accordance with rules and regulations
Dispute Resolution Analyst
07/2011
-
05/2015
New York, NY
- Compiles consumer reports and ensures incorrect or nonmatching information is not disclosed to consumers
- Serves as point of contact for consumers negatively impacted by information reported to financial institutions
- Processes consumer disputes submitted by consumers, e.g., identity theft, fraud claims, by identifying the consumer’s dispute and properly documenting it in the consumer’s file. Places security alerts and security freeze requests as appropriate
- Troubleshoots consumer’s problems, identifies root cause, and uses appropriate procedures, rules, and resources to resolve consumer disputes and issues
- Investigates consumers’ disputes and communicates with information source to verify accuracy of reported information and takes appropriate action to resolve the consumer dispute, i.e., deleting the information if no response within required timelines, interpreting responses, evaluating sufficiency of information, and following up
- Meets performance standards, e.g., accuracy audits, phone monitor results, quality standards, and adherence to required timelines
- Resolving all issues on customer’s invoices
- Review and evaluate whether the claim from the customer is valid by analyzing all processes involved in the billing workflow to determine if a correction is needed and do all necessary to have it resolved
Claims Resolution Analyst
11/2004
-
02/2011
Los Angeles, CA
- 1 – 2 years of experience in similar jobs
- Great attitude, team work and willingness to learn
- Follow instructions, prioritize effective
- Experience in the use of standard Microsoft software Outlook, Word and Advanced Excel
- 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
- Evaluate whether the claim from the customer is valid by analyzing all processes involved in the billing workflow to determine if a correction is needed and do all necessary to have it resolved
- Resolve and respond all related disputes from Customers by responding directly or by obtaining the proper person to resolve the situation
- Review documentation provided by collections or customers and determine accuracy whether the claim from the customer is valid and matches the supporting documents
Education
Drexel University
1998 - 2003
Bachelor's Degree in Related Field
Professional Skills
- Excellent typing, data entry, and computer skills
- Strong problem solving skills – the ability to initiate creative solutions to difficult business issues
- Strong work ethic, and advanced problem solving/analytical skills
- Excellent interpersonal, verbal, written communication skills
- Experience with claims auditing and researching claims information (experience healthcare billing, claims, auditing, reimbursement, or data)
- Knowledge and understanding of basic customer service skills including phone and email etiquette
- Prior experience in the Accounting or Railroad field
How to write Resolution Analyst Resume
Resolution Analyst role is responsible for organizational, database, research, organization, word, security, finance, credit, training, auditing.
To write great resume for resolution analyst job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Resolution Analyst Resume
The section contact information is important in your resolution analyst resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Resolution Analyst Resume
The section work experience is an essential part of your resolution analyst resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous resolution analyst responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular resolution analyst position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Resolution Analyst resume experience can include:
- Assist the firm's Legal Department with the preparation of discovery documents related to pending arbitrations and/or litigations involving customer complaints.
- Strong interpersonal skills including the ability to interact effectively with and influence personnel at various levels throughout organization
- Effective written and verbal communication skills, superior interpersonal skills and a sense of urgency
- Demonstrated experience in managing multiple priorities, working under pressure and meeting deadlines
- Finance/Accounting oriented area with trade credit focus, proven knowledge of billing systems, and credit/collection practices and procedures required
- Experience in a relevant project management, analytical, or customer-facing role (or similar)
Education on a Resolution Analyst Resume
Make sure to make education a priority on your resolution analyst resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your resolution analyst experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Resolution Analyst Resume
When listing skills on your resolution analyst resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical resolution analyst skills:
- Solid personal computer skills, including when working with email, recordkeeping, routine database activity, word processing, spreadsheets, etc
- Effective analytical, problem-solving, and time management skills
- Strong analytical and communication (oral and written) skills - the ability to distill lots of data unto useful information
- Solid leadership/interpersonal skills – the ability to work well as a team member and to influence business decision-makers
- Solid skills with Microsoft Excel, Power Point and Word
- Manage time effectively while consistently meeting targeted deadlines
List of Typical Experience For a Resolution Analyst Resume
1
Experience For Dispute Resolution Analyst Resume
- 1-year related experience and/or training required
- Independently prioritize and multi-task, with the flexibility to adapt quickly to change
- Experience in credit internally and collections
- Work independently, comfortably making rational and reasoned decisions which directly impact customer experience
- Documenting the issue and resolutions in the database, while adhering to the strict
2
Experience For Senior Recovery / Resolution Analyst Resume
- Analyzing issues related to the pharmacy within Medicare Part D
- Documenting the issue and resolutions in the database,
- Demonstrating proficiency on assigned audits
- Reviewing claimant spend-patterns,
- Conducting in depth research on member issues in order toprovide quality resolutions
- Communicate in writing in a clear and concise manner to present a clear explanation of the consumer’s dispute
- Reconcile the Stop Loss Reinsurance submissions & recoveries data and follow-up on outstanding Accounts
3
Experience For Claims Resolution Analyst Resume
- Production and quality metrics along with defined turnaround times are achieved on an ongoing basis
- Audit findings are documented and submitted according to standard practices for the client
- Communication updates with internal and external clients for outstanding title conditions
- Responsible to prepare CPL’s for buyer/sellers and lenders depending on the region
- Responsible to obtain, review and clear all title requirements including
- Knowledge of claims processing system
- Creatively constructing written formal communication tomembers
- Cross functionally working with various departments toidentify root cause analysis of Member issues
4
Experience For Appeals Resolution Analyst Resume
- Conduct interviews of Financial Advisors or other firm employees in connection with the investigation of customer complaints
- 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
- Input and update basic demographic customer and clinical data for all utilization management
- Turnaround times established by the Center for Medicare and Medicaid Services (CMS)
- Regular, reliable and predictable performance
- Respond to member and consumer requests both orally and through written correspondence in accordance with Federal regulations related to the Fair Credit Reporting Act and Fair Debt Collection Practices Act along with specific state requirements
5
Experience For Customer Resolution Analyst Resume
- Educate and guide consumers through a consumer report request and investigation process, ensuring that regulations and requirements from both a federal and state level are applied
- Interpret and analyze consumer’s written and oral communications
- Document all interactions with the consumer and member institutions
- Educate consumers and offer options for resolution
- Reports accurate information into Acosta’s proprietary network and transmitted on a daily basis
- Input and update basic demographic customer and clinical data for all utilization management programs and Continued Stay Review identifying eligibility via telephone and CRT prior to utilization
- With supervision, initiate and monitor progress and level of care in conjuncture with the physician and other utilization management staff to determine if care is delivered in an appropriate setting to managing health care costs
6
Experience For Business Resolution Analyst Resume
- Educate Plan personnel and accounts on utilization management and data collection and analysis through external presentations and in-house software demonstrations
- Compile and tabulate specific data on utilization management programs to monitor activity and make recommendations as needed
- Orient providers and medical professionals of Cost Containment policies and procedures to expand awareness of Blue Cross and Blue Shield criteria for proper utilization
- One year of mortgage loan experience, preferably in post-closing or underwriting
- Multitasking and working with up to 15 various computerapplications
- Obtain outstanding collateral from clients and closing agents
- Identify and analyze billing trends - report results as required
- Assist with training of new analysts
- Work with internal and external clients to resolve loan issues
7
Experience For Problem Resolution Analyst Resume
- Identify patterns and trends within the audit and provide regular feedback to leadership on issues and opportunities for improvement
- Work closely with the Transaction Management, Operations, Accounting, Servicing and Client Relations teams to ensure loans are made available for trade in a timely manner
- Strong ability to work independently and within a team to strive for common goals
- Follow a variety of instructions in written, verbal or schedule form
- Proficiency in Microsoft Office as well as knowledge of how to work a phone, fax machine, printer and copy machine
- Detail-oriented mindset and the ability to multitask
8
Experience For Senior Recovery Resolution Analyst Resume
- Analyzingissues related to the pharmacy within Medicare Part D
- Analyze documentation, review provider disputes, summarize specifics of review results for all claim types (Facility (DRG) / Professional)
- Attend and participate with onsite provider reviews
- Attend and participate with dispute / administrative hearings
- Responsible for accurate and timely resolution and collection of all Class 1 partner invoices
- Responsible for the Stop Loss Reinsurance submissions, analysis and renewals
- Obtain all relevant Stop Loss Reinsurance claims data from specified System
- Prepare the Stop Loss Reinsurance historical summary to reflect collection ratio per policy year
- Manage & oversight of the Stop Loss Reinsurance Submissions & Recovery System
9
Experience For Title Resolution Analyst Resume
- Analyze data and automate the current processes to make them more efficient
- Provide claims expertise support by reviewing, researching, investigating, negotiating, and resolving all types of claims issues related to the Stop Loss Reinsurance process
- Process Stop Loss Reinsurance checks and post recoveries to applicable System
- Actively participate in all aspects of Revenue Recovery functions as needed
- Prepare and report the month-end financials for the Revenue Recovery department
- Responsible to the Regional Credit Operations leader and accountable for the execution of dispute resolution procedures and developing tactics to drive improvement on root cause resolution
- Manages all aspects of the customer dispute portfolio. Ensuring that access for all required personnel is provided and maintained, continuing with disciplined processes, controls and metrics
- Connect to businesses in addressing all issues and opportunities related to dispute resolution. Raise awareness of the volume and age of disputes, and define monthly metrics for possibility of write off as well as highlighting accomplishments and improvement opportunities
10
Experience For Claims Resolution Analyst, Seattle Resume
- Improve competency through sharing and learning from North America and global team in leveraging dispute resolution management knowledge and growth support/analytical tools
- Audit paid claims data to identify overpayments
- Investigate and resolve overpayments on all claims types, as well as assist in resolution for health plans, commercial customers, and government entities as needed
- Evaluate, research and monitor disputed items with internal and external customers
- Review CS2 education courses frequently so that collection efforts do not damage customer relationships
- Handle ad hoc audits and referrals associated systems and policies
List of Typical Skills For a Resolution Analyst Resume
1
Skills For Dispute Resolution Analyst Resume
- Maintain good attendance, follow Company core values and demonstrate a high standard of conduct
- Research skills; via phone, websites, payer manuals, etc
- Experience with Microsoft Excel including data entry, sorting, creating, and modifying spreadsheets
- Experience working in a merchant acquiring, card issuing,
- Prioritise needs of stakeholders with different requirements, including Client Services, Sales, Transaction Reporting and I.T teams
2
Skills For Senior Recovery / Resolution Analyst Resume
- Equivalent 8 - 10 years of working experience in Managed Health Care with a combination of the following areas
- Previous experience in claim processing, healthcare provider information and healthcare billing practices
- Previous experience adjusting and processing claims,
- Previous experience resolving claim pricing issues
- Previous experience adjusting and processing claims
- Previous experience reviewing claims and making reimbursement determinations
- Debit/Credit card banking experience
3
Skills For Claims Resolution Analyst Resume
- Demonstrates knowledge of managed care guidelines and government billing requirements
- Experience in Excel - need to be able to create pivot tables, do data entry and data manipulation from existing spreadsheet
- 6 months related experience and/or training required
- Medical record coding experience
- Experience working in the healthcare industry with claims and or recovery
4
Skills For Appeals Resolution Analyst Resume
- Experience working with long term care services
- Experience working with high volume of Stop Loss Reinsurance claims data
- Knowledge and experience in ICD-10 and HCPC coding
- Previous experience resolving provider claims and reimburse disputes
- Experience in Accounts Receivable or Customer Service roles
- Experience in healthcare industry
- Customer service experience is required
- Strong sense of accountability and high sense of urgency
- Proficient knowledge and experience with Microsoft Excel required
5
Skills For Customer Resolution Analyst Resume
- An ability to manage one’s personal time as well as prioritize/focus team members on what’s most important
- Strong core values-personal integrity and ethics
- Experience with medical claims (C&D and / or COB)
- Experience in Optum Waste and Error policies and procedures
- Previous presentation or policy documentation experience
- Health plan and/or claim, financial analysis, or related experience
- CSP experience
6
Skills For Business Resolution Analyst Resume
- COSMOS experience
- Meet aggressive deadlines and handle multiple priorities
- Proven ability in manipulation of large data sets to understand root causes and trends
- Work as part of a team and also independently; strong awareness when to loop in others to problem-solve
- Educating members on their healthcare benefits and ensuring access to life-sustaining medication
- Working knowledge of medical terminology and claim coding
- Meeting or exceeding government mandated timelines
- Acquiring and maintaining basic knowledge of Med D guidelines
- Assessing claimant eligibility for access
7
Skills For Problem Resolution Analyst Resume
- Working knowledge of Microsoft Office Suite (Word, Excel, etc..)
- Working knowledge of the healthcare insurance/managed care industry
- Coordinating issue resolution with Leadership Team
- Utilizing multiple software systems to research Medicare beneficiary plan/pharmacy concerns
- Conveying resolution to beneficiary via direct communication and professional correspondence
- Following turnaround time, productivity and quality standards
- Frequent speaking, listening, using a headset, sitting, use of hands / fingers across keyboard and use of mouse, and working at a computer
- Proficiency within Microsoft Excel (filter, editing, creating, sorting)
8
Skills For Senior Recovery Resolution Analyst Resume
- Intermediate level proficiency with Microsoft Excel (sort, filtering, summing, formulas, formatting)
- Demonstrable ability to analyse information, present findings to a wide audience including senior stakeholders and help in developing solutions
- Capable of working with minimal supervision exercising independent judgment within the scope of knowledge
- Previousexpeirence reviewing claims and making reimbursement determinations
- Responsible to obtain and review a survey for use in clearing exceptions to title and affording certain affirmative coverages to lender customers
- Perform daily balancing of sales and cash receipts activity to ensure accuracy of GL financial reporting
- Financial Acumen, understanding of corporate finance
9
Skills For Title Resolution Analyst Resume
- Adapt to a variety of reporting and analysis systems and tools
- Finance, Customer Service, Accounting, or related disciplines
- Perform patient account research to prevent billing rejections, work with various departments as needed
- Present denials information and findings to Denials Management team and the monthly Committee Against Denials meeting
- An understanding of Options / Futures, Commodities, OTC products and Reconciliations
- PowerPoint - need to be able to create presentation or PowerPoint document from existing template
- PowerPoint - need to be able to create presentation or document from existing template
- Certified Coder (CPC, CCS) and / or LPN / RN Nursing Licensure
- Claim auditing and research of claim information
10
Skills For Claims Resolution Analyst, Seattle Resume
- Computer proficiency in Microsoft Office including Word (create documents) and Outlook (send email / calendar utilization)
- Proficient with personal computers, including Microsoft Suite of products
- Make audit decisions using multiple inputs
- Familiarity with 3-5 claim platforms or similar operating system technology
- Daily monitoring of workflow and assignment delegations from Quality Leads to ensure business metrics are met
- Daily monitoring of workflow and assignment delegations to ensure business metrics are met
- Comfortable with Excel and/or other data manipulation reporting tools (Smartsheets, Google tools, etc.)
List of Typical Responsibilities For a Resolution Analyst Resume
1
Responsibilities For Dispute Resolution Analyst Resume
- A responsibility of this role is to continually look for new opportunities in data they are reviewing and to seek and suggest process improvements
- Keep files and work area organized
- Type 30 wpm needed
- Navigate between various computer applications quickly
- Examine specific client revenue performance as assigned against regional/segment baseline indicators using a suite of standardized metrics; identify drivers of problems, root cause analysis, facilitate proactive outreach to clients and/or client support teams to improve client outcomes
- Perform complex claims analysis, identify trends and root causes of payment inaccuracies
- Ensure all audit results are supported by documentation, contract, state and client compliance is followed
- Maintain any databases and spreadsheets related to assigned work
- Work collaboratively with all internal and external parties
2
Responsibilities For Senior Recovery / Resolution Analyst Resume
- Monitor and manage all aspects of assigned responsibilities by organizing, planning and tracking assigned tasks and priorities to ensure financial and client service level commitments are exceeded
- Research relevant systems and documentation and solve for open issues such as contract documentation and discrepancies
- Support the overall team objectives
- Highly proficient with Microsoft Office Suite (Excel, Word, PowerPoint)
- Cultural fit personally and professionally within the Customer Experience group possessing an outgoing personality to deliver the best service for our customers, external stakeholders, and internal employees
- Perform special studies and projects to meet departmental goals
- 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
- Certified Coder (CPC or CCS) and / or current LPN / RN Licensure
3
Responsibilities For Claims Resolution Analyst Resume
- Drive results through virtual and or cross functional teams
- Certified Professional Coder (CPC) or Registered Nurse (RN)
- Travel up to 25% of the time within the State of MA
- Responsible for investigation and resolution of discrepant AR payments (deductions, chargebacks and over payments) customer account reconciliation to improve days sales outstanding (DSO)
- Post and reconcile daily cash receipts (checks and wire transfers) to lock-box deposits
- Conduct periodic lock-box studies of cash management process to ensure efficient AR performance
- Assist channel managers with customer account risk assessment utilizing nationally accepted credit rating systems (D&B Reports) and corporate policies interpreting financial ratios to protect cash flow
4
Responsibilities For Appeals Resolution Analyst Resume
- Ensure the integrity, accuracy and timeliness of receivables month-end process and publish Accounts Receivable report requirements
- Cycle time measures on dispute resolution
- Reduction in the overall number of disputes
- “easy to do business with” customer survey scores
- "time back to sales" improvements via sales survey scores
5
Responsibilities For Customer Resolution Analyst Resume
- Review and resolve analyst and Quality Lead escalations
- Complete approval and Claims Decision Database entries
- Complete complex assignments and coordinate related activities
- Review and resolve analyst escalations
- Initiate and investigate consumer requests in a timely and considerate manner
6
Responsibilities For Business Resolution Analyst Resume
- Clinical Inventory Management-75%
- Knowledge of CMS 1500 claim form
- Medicaid / Medicare Reimbursement methodologies
- Certified Inpatient Coder (CIC)
- Certified Outpatient Auditor (COC)
- Analyze large sets of data to identify mispaid claims, and identify trends/root causes
- Create, edit, copy, send and save documents, correspondence, and spreadsheets in MS Word and Excel
- Interpret multiple payment processes, methodologies and policies
7
Responsibilities For Problem Resolution Analyst Resume
- In-depth knowledge of managed care and government operations/products
- Make decisions and work independently in a fast-paced environment
- Analyze large sets of data to identify mispaid claims, and identify trends / root causes
- Facilitate the clearance of paid and unreleased mortgages and liens of public record
- Research and provide payoffs for open liens and judgments
- Responsible to obtain, review and clear all title requirements including: Condo or Homeowners Association Statements and Entity Documents (LLC’s/Corporations)
- Preparation of Corrective Instruments
- Knowledge of Bankruptcy and Foreclosure proceedings
- Review of trusts, divorces, probate, land contracts and other types of conveyance instruments for compliance in the issuance of title insurance
8
Responsibilities For Senior Recovery Resolution Analyst Resume
- Condo or Homeowners Association Statements
- Document the issue and resolution in the database, while adhering to the strict turnaround time established by CMS Share the outcome with the customer through verbal and/or written correspondence
- Root cause analysis of Accounts Receivable payment variances to identify process improvements and corrective actions to mitigate collection risk and improve customer service
- Entity Documents (LLC’s/Corporations)
- Type 30-50 wpm
- Navigate between multiple computer applications quickly
9
Responsibilities For Title Resolution Analyst Resume
- An adequate knowledge of information security principles
- Identify issues and recommend process improvements
- Follow instructions and procedures properly in a fast paced work environment
- Leverage research tools to execute sound decisions
- Exceptional verbal, written, and interpersonal communication
- The ability to occasionally work off hours to support the global
- Identify payment discrepancies and initiate dispute resolution to facilitate rapid turnaround of payments
10
Responsibilities For Claims Resolution Analyst, Seattle Resume
- Contact customers regarding aging accounts due to invoicing discrepancies and disputes for resolution. Demonstrate effective decision making skills and open communication with customers
- Maintain contact with customers and AR Collectors in order to address and resolve all payment issues timely
- · Experience in customer service, call center, or other service organization inahigh volume working environment,handling confidential informationand resolving customer sensitive issues timelyandaccuratelyandinaccordance with procedures, rules,andregulations
- Experience in customer service, call center, or other service organization in a high volume working environment, handling confidential information and resolving customer sensitive issues timely and accurately and in accordance with procedures, rules, and regulations
- Working knowledge of the Fair Credit Reporting Act (FCRA), the Fair Debt Collection Practices Act (FDCPA), the Fair and Accurate Credit Transactions Act (FACTA)
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