Jennifer Robledo

Evernorth Telehealth – MDLIVE | Orlando, FL

Claims Analyst & Medical Coder | Feb 2023 – Present

• Analyze and process claims to ensure accurate CPT, ICD-10, and HCPCS coding compliance.

• Investigate claim denials, identify discrepancies, and submit appeals to maximize reimbursements.

• Monitor payer policies and update coding guidelines to align with regulatory changes.

• Conduct claims audits to detect errors, prevent revenue loss, and improve billing accuracy.

• Collaborate with stakeholders to resolve claim issues and enhance claims workflow efficiency.

•Certified Coder/ Edit Dispute Resolution Analyst

• Responsible for auditing and reviewing medical records for complex, multi-specialty provider claims to determine accurate coding and billing practices.

• Analyzing provider-submitted claims and comparing them against Zelis Claim Edits to ensure compliance with coding policies.

• Investigating and resolving client and provider disputes related to coding and adjudication.

• Acting as a subject matter expert in claim edits, coding guidelines, and dispute resolution processes.

• Collaborating with internal teams to escalate and route complex cases when necessary.

• Maintaining compliance with industry standards, payer guidelines, and regulatory requirements.

• Processed and analyzed specialty pharmacy claims to ensure proper coding and reimbursement.

• Investigated rejected claims, submitted corrections, and reduced denial rates by 25%.

• Worked closely with payers to resolve complex claim disputes and appeals.

• Conducted internal audits to identify coding errors and compliance risks.

• Led administrative team operations, training new hires, and streamlining office workflows.

• Acted as a liaison between patients and providers, resolving scheduling and insurance issues.

• Ensured compliance with department policies and optimized front desk functions.

• Managed daily OR schedules, coordinating with nurses and surgical teams.

• Scheduled GYN and OB procedures, pre-admission testing, and patient follow-ups.

• Implemented scheduling improvements that enhanced surgical team efficiency.

• Scheduled orthopedic surgeries, pre-op, and post-op appointments.

• Verified insurance eligibility and pre-authorizations for scheduled procedures.

• Maintained surgeon’s Outlook calendar for surgeries, clinic hours, and meetings.

• Audited and coded cardiothoracic surgery claims to prevent billing discrepancies.

• Obtained pre-authorizations and ensured proper coding documentation for insurance approvals.

• Managed insurance verification, improving claims accuracy and reimbursement rates.

Reviewed patient eligibility, obtained prior authorizations, and verified insurance coverage.

• Ensured coding accuracy for oncology procedures and supportive treatments.

• Assisted patients with financial assistance programs and reimbursement options.

•Held various roles in medical billing, coding, claims processing, and patient financial services.

• Gained foundational experience in medical office administration, insurance verification, and reimbursement analysis.

• Developed expertise in payer guidelines, compliance, and revenue cycle optimization.