SIU Analyst - Healthcare Resume Search
SIU Analyst - Healthcare Resume Search
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SIU Analyst Resume


Desired Industry: Healthcare SpiderID: 67146
Desired Job Location: Louisville, Kentucky Date Posted: 2/7/2013
Type of Position: Full-Time Permanent Availability Date: Immediately
Desired Wage:
U.S. Work Authorization: Yes
Job Level: Experienced with over 2 years experience Willing to Travel: Yes, 25-50%
Highest Degree Attained: Bachelors Willing to Relocate: Yes


Experience:
Troy L. Embers, CPC-A
629 Virginia Ave * Louisville, KY 40222 * 502.432.6110 * tembers8@yahoo.com


EXPERIENCE
COVENTRY HEALTH CARE, Louisville, KY
Special Investigator, Special Investigations Unit 2011 - 2012
Investigated potential cases of health care fraud, waste & abuse
Reviewed medical documentation to validate services performed
Prepared case reports for referral to the Health Plan, OIG, & other outside agencies
Identified & coordinated a plan to recover provider overpayments due to FWA
Completed provider claims data queries for overutilization & improper coding reviews

HUMANA INC., Louisville, KY
Special Investigator, Special Investigations Unit 2010 - 2011
Investigated potential health care fraud, waste & abuse allegations
Gathered data from multiple resources to build special investigation cases
Prepared cases for referral to management, market contacts & law enforcement
Conducted phone interviews to substantiate or disprove allegations of fraud
Lead conference calls with management & market representatives to review case findings
Reviewed medical records to verify services rendered & correct codes were billed
Created education letters for providers to correct billing variances

HUMANA INC., Louisville, KY 2009 - 2010
Analyst, Provider Relations
Researched & resolved complex provider claims payment inquiries
Consulted with internal departments to fix the root cause of claims payment errors
Lead monthly calls with providers to discuss & address systemic claims payment inquiries
Assisted providers with questions & concerns regarding coding edits & contract rates

HUMANA INC., Louisville, KY 2005 - 2009
Analyst, Provider Network Operations
Reviewed & resolved complex provider claims payment inquiries
Recovered overpayments due to incorrect contract set-up
Helped create training documents for new specialist & analyst
Helped train associates how to research & resolve provider claims inquiries
Earned Star Award for exceptional work on a claims project that corrected over $200,000 in
claims payment

HUMANA INC. (Adecco), Louisville, KY 2003 - 2004
Data Conversion Specialist, Provider Network Operations
Loaded provider contract & demographic information into database systems
Converted old provider data into new database
Audited provider contract files in database system to ensure accuracy


NATIONAL CITY BANK, Louisville, KY 1999 - 2002
Proof Operator, Item Processing
Encoded & balanced daily branch deposit transactions
Verified bank documents
Earned Employee of the Month Awards

CERTIFICATIONS
Certified Professional Coder (CPC-A), AAPC 2011

EDUCATION
UNIVERSITY OF LOUISVILLE, Louisville, KY



Education:
University of Louisvlle, Bachelor of Science, Justice Administration


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