Data Analyst Customer Relations
Resume:
Eliana Hinojos
Data Analyst Translator Instructional Design
Las Vegas, Nevada
ad7qxr@r.postjobfree.com
https://www.linkedin.com/in/eliana-hinojos-
35b14737
Highly motivated with over 10 years of experience in strategic operations, Revenue Claims Data Analyst, Billing Cycles, Emotional Intelligence, and Customer Relations. With depth knowledge in monitoring internal and external data reports. By utilizing my problem-solving and task management skills while gathering, analyzing, interpreting, and presenting. Understand the live cycle of medical claims while compliant with HIPPA and confidentiality regulations. Skills
• Strong Critical thinking • Time Management • Proficient in Microsoft & Google Suite
• Translator – English/Spanish • Reconciliations • Revenue Growth & Operations
• Accounting Journals • Diversity, Equity, & Inclusion • Training & Development Professional Experience
OCTOBER 2023 – PRESENT
Performant’s mission is to help commercial healthcare and government payers enhance revenue and contain costs by identifying, preventing, and recovering waste, improper payments, and defaulted assets. Performant is a leading provider of these services in several markets, including Medicare, Medicaid, and commercial healthcare.
Revenue Integrity Operational Analyst Performant Financial Corporation, Remote
• Analyze a weekly pipeline report with an average of 10 – 15 thousand claims daily to help commercial healthcare and government payers, as a result company increase net revenue and identify millions in missed charges.
• Analyzed, researched, identifying trends, error codes, and resolved moderate to complex issues and variances that arose from Medicare insurance including inpatient claims, outpatient claims, and medical equipment claims utilizing excel and other system reports to process payments.
• Protect patients’ privacy by understanding and adhering to HIPPA standards and regulations.
• Communicate effectively with carriers to determine primacy; answer questions and/or provide information that will lead to successful payment or other appropriate account action.
• Initiate applicable action and documentation based on upon insurance carriers selected.
• Update team’s database systems with clear and accurate claim category information
• Help initiate training manuals to support and educate new team members of the claims process and denial and resolution payment process.
• Initiated first training manuals for team members, acting as lead.
• Researched and analyzed records (legal, financial, etc.) to obtain data needed to secure and enforce Medicare cases.
• Conducted complex reconciliation activities related to Medicare payments and overpayments/underpayments.
2
OCTOBER 2022 – OCTOBER 2023
Patient Accounts Specialist Universal Health Services Western Region CBO, Las Vegas, NV The Western Region CBO provides services including appeals/denials, billing, collections, cash posting pre-access management, variance, and customer service to affiliated UHS facilities in Nevada and California following & protecting patient HIPPA privacy.
• Responsible for the maintenance and processing of patient accounts and hospital insurance. Ensuring timely and accurate payment from insurance carrier
• Analyzed payer EOB to determine appropriate payment is received while following internal procedures with insurance companies.
• Responsible to write dispute letters & Appeal letters based on payer contract guidelines, utilize software to review and track the life of a denial.
• Check claim status via online and through the Payer Portals by confirming eligibility and updating the insurance plan based on verified insurance coverage and treatment authorization.
• Investigate to determine the proper order of insurance for the billing department by updating the correct IPLAN & patient demographic information in SMS system.
• Contact healthcare insurance carriers, employers, & patients regarding eligibility discrepancies
• Work on payers-based spreadsheets and communicate trends to leadership.
• Participate in payer conference calls, trend analysis and meetings weekly, and departments quotas while handling a variety of payers with the proven ability to multitask.
• Confirmed payments by completing DRG PRICER for IP & REHAB claims following CMS guidelines,
• Confirmed payments for OP claims based on contractual rates by Procedure CPT codes.
• Complete contractual adjustment and denial adjustment following insurance contractual rates following Medicare, Commercial, and Medicaid guidelines.
• Software: CMS, ARTIVA, AVAILITY, ONESOURCE, MRO, COBIUS, DI,
• Health Portals: Optum, Intermountain, SCAN, KAISER, HPN, United Health Care, UMR, Prominence, EPIC, Alignment, CAREMORE, P3 Health, Anthem BCBS, etc. OCTOBER 2016 – JULY 2022
Lead Instructor Doral Academy & Stanford Elementary, Las Vegas, Nevada
• Attend monthly district instructional leadership meetings to use data to adapt at incorporating a variety of traditional and progressive techniques with the use of technology.
• Prepare curriculum to meet developmental goals and instructional activities according to students’ academic needs and team professional developments maintaining state standard objectives.
• Develop strategies to effectively prepare students for exams resulting in a 10% increase in state scores.
• Use background in education studies to create Goal setting charts to improve grade level data by analyzing reports from Northwest Evaluation Association who partners with over 3,500 educational organizations.
• Create and facilitate online trainings with schools’ strategic improvement plan to help parents understand how to navigate google classroom, school technology APPS, and new academic strategies. As a result, received five reward certifications for 100% parent attendance during conferences.
• Perform all administrative roles: coordinate, manage, plan, keep, communicate, and accommodate the needs of the department using Microsoft Excel and other Microsoft Office applications, Outlook, Plan book, and Infinite Campus to keep track of student data.
• Improve student engagement by implementing student-centered classroom management techniques that foster academic curiosity.
3
• Help students learn to persevere through challenging tasks and build resilience for future educational efforts.
• Implement diverse teaching methods such as lectures, discussions, and demonstrations in core subject areas (reading, writing, math, science, and social studies)
• Ensure students can make real life connections throughout their learning process.
• Implement remedial programs for students requiring extra assistance and targeted support.
• Collaborate with colleagues to plan and schedule lessons promoting learning and student engagement.
• Responsible for learning different types of tech tools and software to help facilitate presentations using Nearpod, Whiteboard chat, Canva, Seesaw, Dojo, Kahoot, and more. OCTOBER 2011 – FEBRUARY 2016
Performant’s mission is to help commercial healthcare and government payers enhance revenue and contain costs by identifying, preventing, and recovering waste, improper payments, and defaulted assets. Performant is a leading provider of these services in several markets, including Medicare, Medicaid, and commercial healthcare.
Revenue Integrity Operational Analyst Performant Corporation, Livermore, California
• Analyze a weekly pipeline report with an average of 10 – 15 thousand claims daily to help commercial healthcare and government payers, as a result company increase net revenue and identify millions in missed charges.
• Analyzed, researched, identifying trends, error codes, and resolved moderate to complex issues and variances that arose from Medicare insurance including inpatient claims, outpatient claims, and medical equipment claims utilizing excel and other system reports to process payments.
• Protect patients’ privacy by understanding and adhering to HIPPA standards and regulations.
• Communicate effectively with carriers to determine primacy; answer questions and/or provide information that will lead to successful payment or other appropriate account action.
• Initiate applicable action and documentation based on upon insurance carriers selected.
• Update team’s database systems with clear and accurate claim category information
• Help initiate training manuals to support and educate new team members of the claims process and denial and resolution payment process.
• Initiated first training manuals for team members, acting as lead.
• Researched and analyzed records (legal, financial, etc.) to obtain data needed to secure and enforce Medicare cases.
• Conducted complex reconciliation activities related to Medicare payments and overpayments/underpayments.
• Kept current with contractual requirements and regulations with Medicare and commercial clients (Humana and Cambia) keeping each share point updated.
• Reviewed and researched a high volume of claims/transactions within each corresponding MAC: FISS/MCS/VMS
• Identified causes of discrepancies such as medical error codes: MISS, PRVA, UDAD, INVL, C140, C091, 027, etc. (DRG, HCPCS, UNITS)
• Completed all sub-contractor invoice processing and reconciliation for PRGX, VERITAS, ICORE, IHEALTH, CAMBIA, and HUMANA maintaining HIPPA certification.
• Interfaced and communicated with technical and IT departments regarding reconciliation of a high volume of transactions and data (incoming and outgoing electronic files, initial outcomes HIGLAS files, mass Adj. files, etc.)
• Prepared Monthly Appeal Statistics Analysis for Centers of Medicare maintaining discretion and confidentiality while extracting reports from the RAC Data Warehouse 4
MAY 1999 – SEPTEMBER 2011
Dedicated full-service moving company committed to moving families and government employee’s interstate and cross-country moves with the best service possible. Strives to provide a premier customer experience and profitable growth for the agency. Revenue Cycle Billing Analyst United Rossiter Relocation, Livermore, California
• Responsible for overseeing the billing process utilizing various billing systems for customers from beginning to end.
• Processing wire payments to subcontractors
• Maintaining organized financial records to aid reporting and calculation bill totals by looking through preview financial statements
• Process National Accounts invoices for Stanford, NASA, and Military Agencies
• Post payments accurately and expeditiously to ensure proper records handling and fast payment responses.
• Initiate private payment collections from private insurances or national accounts, cancellations, denial, or other issues.
• Responsible for performing monthly closings and reconciliations.
• Telephone operations helping customers with special billing request.
• Performing clerical duties such as typing, sorting mail, and updating directory information utilizing company software, Microsoft Word and Excel, and Outlook Education
AUGUST 2022
Certificate Medical Billing Universal Classes
NOVEMBER 2016
License for Educational Personne K-12 State of Nevada DECEMBER 2012
Certificate Medical Terminology & Coding Las Positas College, Livermore, California SEPTEMBER 2008
Bachelors of Science California State University, East Bay, Hayward, California MAY 2005
Associates Liberal Arts Las Positas College, Livermore, California Activities
• Literature • Volunteering • Arts • Yoga • Hiking • Travel References
• Upon Requested
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