Medical Claims Analyst | Billing Specialist | Insurance Follow-up Expert

Ensuring all billing follows strict federal laws (like HIPAA) and insurance company rules to avoid audits and heavy fines. Identifying why claims are being denied (e.g., missing signatures or incorrect ID numbers) and fixing those errors before they cost the practice money. Skilled in outbound communications with insurance companies to track claim statuses. I have a proven track record of drafting and sending effective appeal letters to overturn denied claims and maximize revenue recovery.

Expertise in managing payment applications and tracking claim payments. I ensure that financial records are accurate by reconciling payments and following up on outstanding balances with insurance providers.

Strong background as a Data Analyst (Accenture) with a focus on processing high volumes of information with precision. I am skilled at identifying trends in data, maintaining database integrity, and providing actionable insights to improve operational efficiency.

Experienced in the full lifecycle of medical claims, including prior authorization, claim submission, and denial management. I am proficient in reviewing medical records to ensure accuracy and compliance, reducing claim rejections for healthcare providers.

Analyzing "Explanation of Benefits" (EOB) and "Electronic Remittance Advice" (ERA) to identify root causes for denials and submitting effective appeals.

Providing reports to providers to show which insurance payers are slow to pay or which services are the most profitable.

Experienced in handling professional inquiries via phone and email. Whether I am calling patients to clarify information or coordinating with insurance adjusters, I maintain a high level of professionalism and clear communication.

Performing pre-authorizations and verifying patient insurance coverage to prevent front-end denials.

Managing the process of getting providers "in-network" with various insurance payers.