Dedicated and high-achieving honor student in Medical Billing and Insurance Coding with a proven track record of academic excellence. Proficient in interpreting medical documents and coding procedures with precision. Fluent in both English and Spanish, fostering seamless communication and understanding in diverse healthcare settings. Possesses a strong grasp of medical terminology, coupled with a deep understanding of insurance billing processes. A detail-oriented professional committed to accuracy and efficiency in healthcare administration. Eager to apply academic prowess and bilingual fluency to contribute positively to the healthcare industry.
Carried out comprehensive multi-layered link analysis of all fraudulent accounts to propose and execute the best practices. Manage unauthorized transactions and fraudulent accounts /activity by overseeing customer and transaction records. Formulate standardized reports and maintain appropriate data using numerous third party and in house tools. Deliver valuable support to business continuity emergencies for unhindered business operations. Devise and implement effective strategies regarding specific fraud initiatives to secure fraud management projects within time and budgetary constraints.
Determined and met coaching requirements and implemented appropriate actions in accordance with quality guidelines. Established quality assurance department by leading a competent team and producing new material for training and improvement opportunities related to investigation flows and presentations. Conceptualized and rolled- out robust risk testing, fraud prevention, and internal control roadmaps in compliance with corporate protocols.
Proposed case following patterns by assessing chargebacks on a daily basis. Administered quality assurance activities such as internal audits
Key Achievements:
▪ Achieved fraud objectives by coordinating with internal and external business partners to address Ad Hoc requests and overcome technical issues while providing expert opinion to employees.
▪ Organized training session for analysts to detect the biggest fraud MO by leveraging SQL database.
HIPAA Certified