Medical Billing | Claims Review Specialist | Coding

Experienced in supporting medical insurance operations through accurate claims review, medical billing analysis, and documentation validation. Skilled in ensuring compliance with insurance policies, Workers’ Compensation guidelines, and client-specific requirements. Proficient in reviewing medical bills for accuracy, medical necessity, and completeness, auditing supporting documents, and maintaining data integrity across healthcare systems. Adept at working with medical billing platforms, EHR/EMR documentation, and CRM or case management tools to ensure timely and efficient claims processing while meeting quality standards.

Experienced in medical billing operations, including medical bill review, claims processing, and documentation validation. Skilled in reviewing medical charges for accuracy, completeness, and medical necessity, with a strong focus on Workers’ Compensation compliance. Proficient in handling high-volume billing workflows, identifying discrepancies, and ensuring adherence to insurance and client guidelines. Experienced in working with medical billing systems, EHR/EMR documentation, and CRM or case management tools to support timely and accurate reimbursement processing.

Knowledgeable in medical coding fundamentals with experience reviewing medical bills and documentation for code accuracy and consistency. Familiar with ICD-10 and CPT codes in the context of medical billing, claims review, and Workers’ Compensation cases. Experienced in identifying coding discrepancies, supporting documentation validation, and ensuring alignment between reported services and billing details. Works closely with billing and claims teams to maintain compliance, data integrity, and accurate reimbursement processing.

Experienced in supporting medical services operations through accurate medical billing, claims review, and documentation management. Skilled in reviewing medical records, treatment documentation, and billing details to ensure medical necessity, accuracy, and compliance with insurance and Workers’ Compensation guidelines. Works closely with healthcare providers, insurance teams, and internal stakeholders to support efficient service delivery, timely claims processing, and high-quality healthcare operations.

Highly experienced in accurate and efficient data entry within healthcare and insurance environments. Skilled in entering, validating, and updating medical claims, billing information, claimant details, and provider records using standardized formats and internal systems. Known for maintaining high data accuracy, confidentiality, and consistency while meeting productivity and turnaround time requirements. Experienced in working with databases, document management systems, and CRM or case management tools.

Experienced in professional email management within healthcare and insurance environments. Skilled in monitoring, organizing, and responding to emails related to medical claims, billing inquiries, provider coordination, and internal case updates. Ensures timely, accurate, and confidential communication while adhering to HIPAA guidelines and company protocols. Proficient in prioritizing messages, maintaining organized inboxes, and supporting efficient workflow coordination.

Knowledgeable in HIPAA privacy and security standards as applied to medical billing, claims review, and healthcare documentation handling. Experienced in maintaining confidentiality of protected health information (PHI) while processing medical claims, reviewing billing records, and managing electronic and paper-based medical documents. Adheres strictly to data privacy policies, secure access protocols, and organizational compliance guidelines to support accurate, ethical, and compliant healthcare operations.

Proficient in Microsoft Excel for healthcare and insurance operations, including data entry, validation, tracking, and reporting. Experienced in using Excel to manage medical claims data, billing records, provider lists, and audit logs. Skilled in applying formulas, filters, sorting, and basic lookup functions to ensure data accuracy, organization, and efficiency. Utilizes Excel to support productivity tracking, quality monitoring, and operational reporting.

Experienced in providing administrative support within healthcare and insurance environments. Skilled in handling documentation, data entry, email management, and record maintenance to support medical billing, claims processing, and provider coordination. Ensures accuracy, organization, and confidentiality while supporting daily operations, meeting deadlines, and maintaining compliance with healthcare standards and HIPAA guidelines.

Experienced in supporting patient care operations through accurate medical billing, claims review, and documentation management. Assists indirectly in patient care by ensuring correct billing, timely claims processing, and access to accredited medical providers, contributing to a smoother healthcare experience. Works with patient-related data while maintaining confidentiality, accuracy, and compliance with healthcare standards and HIPAA guidelines.

Experienced in supporting provider credentialing and panel management processes within healthcare and insurance environments. Skilled in processing and maintaining provider listings, panel postings, and accreditation records to ensure providers meet client, payer, and regulatory requirements. Works with accurate documentation, data validation, and internal systems to support timely provider onboarding, updates, and compliance tracking.

Strong working knowledge of medical terminology, healthcare documentation, and clinical service workflows as applied to medical billing and claims review. Experienced in understanding treatment records, provider notes, and billing documentation to support medical necessity evaluation, coding validation, and insurance compliance. Applies medical knowledge to ensure accuracy, consistency, and quality across healthcare and insurance operations.

Working knowledge of ICD-10 diagnosis codes as applied to medical billing, claims review, and documentation validation. Experienced in reviewing ICD-10 codes for accuracy, consistency, and alignment with medical records to support medical necessity and insurance compliance. Identifies potential discrepancies between diagnosis codes and supporting documentation during bill review and auditing processes.