Palmetto Gba - Senior Quality Analyst Resume Example

Jacob Jones

XXXX XX XX X, South Portsmouth, KY 41174

Ph: XXXXXXXXXXXX

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Professional Summary

I have 27 years of work experience with Palmetto GBA, an organization which processes and audits medicare claims. For the past three years I served as a Senior Quality Analyst. I served with the Appeals department for four years, and a claims analyst for 19 years. My skills and experiences include: auditing, budgeting, database administration, policy analysis, multi-tasking, analyzing medical claims data and retrieving electronic documents for processing. My job previous to this for 2 years at Hilltop Health Center I was a Receptionist/interviewee and I interviewed clients to see if they qualified to be eligible to receive medical and food assistance and the WIC program. Arranged transportation for clients. I also set up additional appointments for clients if needed. Previous to this job I worked for Attorney Richard Hunter for one year as the receptionist I interviewed clients, handled all incoming and outgoing phone calls. Typing, dictation. Interviewed clients and scheduled appointments.

Skills

Microsoft Office, Auditing, Budgeting, Database Administration. Policy Analysis, spreadsheets, microsoft excel, microsoft word, qualtrack, secretarial. ICD-9 Medical Coding, Procedure codes, coding claims. Excellent witten and verbal communications skills. Appeals processing, telephone skills, appeals interviews, general office equipment, multiline phone systems, scanners, general office duties, , verbal communication skills and writing. Interviewer, scheduling.

Experience

Senior Quality Analyst Jun 1987－Sep 2013 Palmetto GBA － Wheelersburg, Ohio Conducted internal audits, audits of individuals, audits of an organization. Developed auditing systems. Collected and analyzed financial data. Determined compliance with laws and regulations. Detected problems like duplicated work, unnecessary spending, fraud, non-compliance with laws and regulations, non-compliance with management policies. Interviewed workers about records and transactions. Ensured resolution of audit findings and resolutions Used database software, spreadsheet software Audited large budgets including Medicare claims.

Receptionist/interviewee Jun 1985－Jun 1987 Hilltop Health Center － Columbus, Ohio Interviewed clients to see if they qualified to be eligible to receive medical and food assistance. This was a government funded office. We provided medical services. applications for the WIC Programs and applications for the food assistance programs. Arranged transportation for the clients if needed. I interviewed the clients to see if they qualified for the programs. Set up additional appointments for the clients.

Receptionist May 1983－May 1984 Attorney Richard Hunter － Portsmouth, Ohio Front desk receptionist. I interviewed clients, handled all incoming and outgoing phone calls. Performed typing and dictation (this was before computers existed) I interviewed all clients in person. If they met the criteria I would then schedule an appointment for them with the attorney.

Education

High School Diploma May 1983 Greenup County High School － Greenup, KY I also have a year of executive secretarial studies at Southeastern Business College- no degree.

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Senior Quality Analyst Receptionist Quality Analyst