FATEMA AKHTER
Dallas,TX
Summary
Dedicated Healthcare Claims Specialist with over 8 years of experience supporting commercial, Medicare, and Medicaid health plans. Proficient in benefits investigation, insurance verification, claims processing, prior authorization, reimbursement follow-up, and claim resolution. Expertise in reviewing medical documentation and verifying insurance coverage while effectively communicating with providers and insurance companies to resolve coverage issues, ensuring timely patient care. Recognized for maintaining accuracy, meeting productivity goals, and delivering exceptional customer service in fast-paced remote healthcare environments.
Overview
11
11
years of professional experience
Work History
Claim Specialist
McKesson – Merck Access Program
10.2025 - Current
- Verified insurance coverage and benefits, including prior authorization requirements, deductibles, copays, and coinsurance, to ensure patient access to necessary treatments.
- Contacted insurance companies to verify coverage and resolve issues impacting patient treatment timelines.
- Coordinated communication between providers, specialty pharmacies, and insurance representatives to streamline patient care processes.
- Conduct benefit investigations for patients receiving Keytruda (J9271).
- Review enrollment forms and obtain missing documentation from provider offices.
- Maintain accurate documentation and HIPAA compliance.
- Worked remotely as a contract employee.
Insurance Claims Specialist
Epiq
09.2024 - 02.2025
- Processed medical insurance claims using ScriptMed, ensuring compliance with policy guidelines.
- Reviewed claims for completeness and billing accuracy, facilitating timely reimbursements.
- Investigated denied and rejected claims to identify resolution opportunities and minimize future occurrences.
- Worked remotely on contract
Healthcare Claims Processor
Centene Corporation
01.2024 - 08.2024
- Reviewed ICD-10, CPT, and HCPCS coding for accuracy and compliance.
- Resolved claim edits and denials to reduce payment delays.
- Processed CMS-1500 and UB-04 claims to ensure timely reimbursement.
Medical Benefit Verification Specialist
CareMetx
11.2022 - 12.2023
- Verified insurance eligibility and benefits to facilitate timely patient access to services.
- Confirmed prior authorization requirements to ensure compliance and minimize delays in care.
- Collaborated with medical provider offices to streamline benefit investigations and enhance patient service delivery.
Medical Telecommunication Specialist
Gateway Health Plan
02.2021 - 10.2022
- Handled high volume of inbound calls, delivering timely customer support and addressing inquiries effectively.
- Guided members through insurance benefits and claims process to ensure understanding and resolution.
- Developed and implemented health plan strategies to enhance member engagement and satisfaction.
- Led cross-functional teams to streamline processes, increasing efficiency in claims processing workflows.
- Analyzed data trends to identify opportunities for operational improvements within care management programs.
Office Assistant
New York City Housing Authority
08.2015 - 01.2019
- Coordinated scheduling for meetings, optimizing senior staff availability and resource allocation.
- Managed office communications, ensuring timely responses to inquiries and efficient information flow.
- Coordinated administrative support and maintained accurate office records to enhance organization.
- Developed filing systems, enhancing document retrieval speed and organization efficiency.
Education
High School Diploma -
Brooklyn International High School
Brooklyn, NYHigh School Diploma -
City College of New York
New York, NYSkills
- Benefits Investigation & Insurance Verification
- Claims Processing (CMS-1500 & UB-04)
- Prior Authorization Review & Follow-Up
- Denials, Appeals & Claim Resolution
- Medical & Pharmacy Benefit Verification
- Eligibility & Coverage Verification
- Commercial, Medicare & Medicaid Plans
- Payer Communication & Reimbursement Resolution
- ICD-10, CPT, HCPCS & J-Code Validation
- Explanation of Benefits (EOB) Review
- Medical Documentation Review
- HIPAA Compliance & Documentation
- Case Management & Account Documentation
- Customer Service Excellence
- Problem Solving & Analytical Skills
Technical Skills
Epic • ScriptMed • Oracle • Citrix • Five9 • Cisco • Microsoft Office Suite • Microsoft Outlook • Microsoft Excel • Microsoft Word • Microsoft Teams
Timeline
Claim Specialist
McKesson – Merck Access Program
10.2025 - Current
Insurance Claims Specialist
Epiq
09.2024 - 02.2025
Healthcare Claims Processor
Centene Corporation
01.2024 - 08.2024
Medical Benefit Verification Specialist
CareMetx
11.2022 - 12.2023
Medical Telecommunication Specialist
Gateway Health Plan
02.2021 - 10.2022
Office Assistant
New York City Housing Authority
08.2015 - 01.2019
High School Diploma -
Brooklyn International High School
High School Diploma -
City College of New York