Malaika Estavien
New York,NY
Summary
Healthcare professional with experience as a Senior Document Service Specialist, Prior Authorization Specialist I, and Payment Integrity Specialist. Skilled in reviewing clinical documentation, processing authorizations, and auditing claims to ensure compliance and accurate reimbursement. Strong knowledge of ICD-10, CPT, and HCPCS coding with a proven ability to reduce denials and improve workflow efficiency.
Dedicated professional prepared to bring extensive expertise and results-oriented approach to Specialist role. Known for effectively managing tasks and supporting organizational goals through collaborative efforts and adaptive strategies. Recognized for excellent communication and analytical skills, ensuring seamless operations and consistent outcomes.
Overview
7
7
years of professional experience
Work History
Payment Integrity Specialist (Remote)
United Healthcare
Texas
10.2022 - 04.2026
- Reviewed and audited medical claims to ensure accuracy, compliance, and adherence to payer policies and regulatory guidelines
- Identified billing discrepancies, coding errors, and potential overpayments, initiating corrections and recovery processes
- Analyzed claims data to detect trends, fraud, waste, and abuse (FWA), supporting cost-containment efforts
- Validated coding (ICD-10, CPT, HCPCS) and clinical documentation to ensure appropriate reimbursement
- Collaborated with providers, payers, and internal teams to resolve claim issues and prevent future errors
- Conducted pre-payment and post-payment reviews to improve claim accuracy and reduce financial risk
- Assisted with denial prevention strategies by identifying root causes and recommending process improvements
- Maintained compliance with HIPAA, Medicare, and Medicaid regulations
- Documented audit findings to support reporting, appeals, and recovery actions
- Managed high-volume workloads while meeting strict productivity and quality benchmarks
Prior Authorization Specialist I (Remote)
Family Practice Center P.C
GA
09.2020 - 10.2022
- Verified patient insurance eligibility, benefits, and coverage details
- Initiated and processed prior authorization requests with insurance carriers
- Reviewed clinical documentation to confirm medical necessity
- Communicated with providers, patients, and insurance companies to resolve issues
- Monitored authorization status and followed up on pending requests
- Identified and resolved discrepancies in coverage and authorization requirements
- Ensured accurate data entry and documentation in billing systems
- Reduced claim denials by securing proper authorizations
- Maintained HIPAA compliance
- Managed high-volume 30 per day and workload with strong accuracy
Document Service Specialist
Harvard Protection Services
New York
11.2018 - 09.2020
- Reviewed and maintained lease agreements, tenant files, and property documents
- Verified documentation met company and legal requirements
- Managed document intake 30+ emails per day, scanning, indexing, and uploads
- Audited files for discrepancies and missing information
- Coordinated with leasing agents and property managers
- Maintained confidentiality of tenant and financial records
- Tracked document workflows and met deadlines
- Supported leasing operations for approvals and renewals
- Improved workflow efficiency and reduced delays
- Assisted in training staff on procedures
Education
M.S. - Management and Leadership
Western Governors University
Millcreek, Ut05-2026
B.S. - Business Administration
Franklin University
Columbus, OH06-2025
A.A. - Business Management
Eastern Gateway Community College
Youngstown, OH 06-2024
Skills
- Payment Integrity & Claims Auditing
- Prior Authorization Processing & Review
- Clinical Documentation Review
- Medical Claims Analysis & Adjudication
- Insurance Verification & Eligibility
- ICD-10/CPT/HCPCS Coding
- HIPAA Compliance
- Revenue Cycle Management
- Appeals Handling
- Provider Communication
- Data Analysis
- Quality Assurance
- Time Management
- Expert problem solving
- Customer relations
- Documentation management
Languages
English
Full Professional
Timeline
Payment Integrity Specialist (Remote)
United Healthcare
10.2022 - 04.2026
Prior Authorization Specialist I (Remote)
Family Practice Center P.C
09.2020 - 10.2022
Document Service Specialist
Harvard Protection Services
11.2018 - 09.2020
M.S. - Management and Leadership
Western Governors University
B.S. - Business Administration
Franklin University
A.A. - Business Management
Eastern Gateway Community College