ANDREINA QUINTANA
Miami,FL
Summary
Medical Claims Analyst with 6+ years of experience in healthcare insurance and revenue cycle operations. Proven expertise in reviewing, processing, and adjudicating medical claims using CPT, ICD-10, and CMS guidelines. Strong background in claims payment, eligibility verification, denial resolution, and HIPAA compliance. Bilingual (English/Spanish) professional seeking a fully remote role in medical claims, billing, or revenue cycle management.
Overview
7
7
years of professional experience
Work History
Medical Claims Analyst
HealthSun Health Plans
Miami, FL, USA
01.2022 - Current
- Reviewed, processed, and adjudicated medical claims using CPT, ICD-10, and CMS guidelines
- Ensured accurate reimbursement according to payer policies and regulatory requirements
- Performed claims payment processing, adjustments, and corrections
- Analyzed EOBs, denials, underpayments, and payment discrepancies
- Collaborated with providers and internal teams to resolve claim issues efficiently
- Maintained HIPAA compliance and confidentiality of member and provider data
- Supported revenue cycle operations to improve turnaround time and payment accuracy
Medical Claims Analyst
HealthSun Health Plans
Miami, FL, USA
01.2022 - Current
- Reviewed, processed, and adjudicated medical claims using CPT, ICD-10, and CMS guidelines
- Ensured accurate reimbursement according to payer policies and regulatory requirements
- Performed claims payment processing, adjustments, and corrections
- Analyzed EOBs, denials, underpayments, and payment discrepancies
- Collaborated with providers and internal teams to resolve claim issues efficiently
- Maintained HIPAA compliance and confidentiality of member and provider data
- Supported revenue cycle operations to improve turnaround time and payment accuracy
Coordinator - Coordination of Benefits
HealthSun Health Plans
Miami, FL, USA
11.2019 - 03.2022
- Reviewed and verified insurance documentation for coordination of benefits (COB)
- Investigated duplicate claims, eligibility discrepancies, and coverage conflicts
- Supported claims resolution to prevent denials and improper payments
- Maintained compliance with CMS and internal regulatory standards
Coordinator - Coordination of Benefits
HealthSun Health Plans
Miami, FL, USA
11.2019 - 03.2022
- Reviewed and verified insurance documentation for coordination of benefits (COB)
- Investigated duplicate claims, eligibility discrepancies, and coverage conflicts
- Supported claims resolution to prevent denials and improper payments
- Maintained compliance with CMS and internal regulatory standards
MSP Verifier
HealthSun Health Plans
Miami, FL, USA
11.2018 - 11.2019
- Reviewed and validated MSP information in compliance with Medicare regulations
- Assigned and monitored dispute and appeal cases
- Maintained detailed audit records and documentation
MSP Verifier
HealthSun Health Plans
Miami, FL, USA
11.2018 - 11.2019
- Reviewed and validated MSP information in compliance with Medicare regulations
- Assigned and monitored dispute and appeal cases
- Maintained detailed audit records and documentation
Education
Associate Degree - Business Administration
Miami Dade College
Miami, FL01.2023
High School Diploma -
Doral Academy
Miami, FL06.2016
Skills
- Medical Claims Processing
- CPT / ICD-10 Coding
- Revenue Cycle Management
- Claims Payment & Adjudication
- EOB Review & Payment Analysis
- Insurance Follow-Up
- Denial Resolution
- HIPAA Compliance
- CMS Guidelines
- Coordination of Benefits (COB)
- Medicare Secondary Payer (MSP)
- Remote Healthcare Operations
- Bilingual: English & Spanish
Timeline
Medical Claims Analyst
HealthSun Health Plans
01.2022 - Current
Medical Claims Analyst
HealthSun Health Plans
01.2022 - Current
Coordinator - Coordination of Benefits
HealthSun Health Plans
11.2019 - 03.2022
Coordinator - Coordination of Benefits
HealthSun Health Plans
11.2019 - 03.2022
MSP Verifier
HealthSun Health Plans
11.2018 - 11.2019
MSP Verifier
HealthSun Health Plans
11.2018 - 11.2019
Associate Degree - Business Administration
Miami Dade College
High School Diploma -
Doral Academy