Nadiea Khan
Yonkers,NY
Summary
Detail-oriented billing and coding professional with extensive training in complex assignments. Skilled in reconciling insurance and patient payments and resolving account disputes. Proficient in various practice management software. Committed to maintain strict patient confidentiality.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Team Lead Analyst, Premium Reconciliation & Billing
Affinity by Molina
10.2021 - Current
- Perform enrollment reconciliation processes for all lines of business (Medicaid, Marketplace, Medicare) in accordance with established policies and procedures.
- Develop and maintain enrollment and financial scorecards and work plans to ensure goals are met or exceeded.
- Ensure all required financial SOX controls are tracked, monitored, and maintained within quality and timeliness measures.
- Investigate and resolve discrepancies between the expected premium billed and the premium received.
- Assist Supervisor/Manager in billing and reconciliation to ensure compliance with Medicare regulations.
- Develop training materials for new recruits.
- Value being a strong team player.
- Train and coach new hires on billing, disputes, and process improvement on member’s accounts.
- Track and follow up on any exceptions or discrepancies with enrollment or revenue amounts expected from CMS or State agencies/exchanges to achieve accurate enrollment reconciliation and maximum premiums collected or recovered.
- Consider downstream and upstream impacts related to other departments due to enrollment-related changes and coordinate with the Center of Excellence team as needed.
- Provide Medicare Part D premium invoice, including premium bill issuance, payment allocation, and reconciliation with the Accounting and Finance Department.
- Assist in the development and testing of external vendor systems to ensure CMS processing guidelines are met within the designated time frames.
- Generate monthly reporting of enrollment-related statistics and various database reports.
- Process enrollee invoices and premium reconciliation for billed members.
- Perform month-end invoicing and accuracy audits.
- Support Member Service representatives to help them resolve member inquiries.
- Assist in resolving escalated premium issues with the Appeals and Grievances team.
- Collaborate with the Enrollment team to resolve eligibility issues affecting premium billing.
Team Lead Analyst, Premium Reconciliation & Billing
Affinity by Molina
10.2021 - Current
- Perform enrollment reconciliation processes for all lines of business (Medicaid, Marketplace, Medicare) in accordance with established policies and procedures.
- Develop and maintain enrollment and financial scorecards and work plans to ensure goals are met or exceeded.
- Ensure all required financial SOX controls are tracked, monitored, and maintained within quality and timeliness measures.
- Investigate and resolve discrepancies between the expected premium billed and the premium received.
- Assist Supervisor/Manager in billing and reconciliation to ensure compliance with Medicare regulations.
- Develop training materials for new recruits.
- Value being a strong team player.
- Train and coach new hires on billing, disputes, and process improvement on member’s accounts.
- Track and follow up on any exceptions or discrepancies with enrollment or revenue amounts expected from CMS or State agencies/exchanges to achieve accurate enrollment reconciliation and maximum premiums collected or recovered.
- Consider downstream and upstream impacts related to other departments due to enrollment-related changes and coordinate with the Center of Excellence team as needed.
- Provide Medicare Part D premium invoice, including premium bill issuance, payment allocation, and reconciliation with the Accounting and Finance Department.
- Assist in the development and testing of external vendor systems to ensure CMS processing guidelines are met within the designated time frames.
- Generate monthly reporting of enrollment-related statistics and various database reports.
- Process enrollee invoices and premium reconciliation for billed members.
- Perform month-end invoicing and accuracy audits.
- Support Member Service representatives to help them resolve member inquiries.
- Assist in resolving escalated premium issues with the Appeals and Grievances team.
- Collaborate with the Enrollment team to resolve eligibility issues affecting premium billing.
Account Receivable Clerk
Affinity Health Plan
11.2019 - 10.2021
- Download payment spreadsheets for CHP, EP & IVR, as well as remote deposit/live checks and money orders.
- Deposit checks and money orders via JP Morgan Virtual Remittance.
- Post payments to member’s accounts.
- Verify member eligibility through Epaces, Facets, Payconnexion, or HBE tool.
- Respond to member inquiries about premiums, payments, gym rewards, or refunds in a timely manner.
- Verify and locate members from a weekly CAN’T ID list to post their payments.
- Work on open AR reports to verify if payment was received.
- Respond to emails through MAAR regarding refunds, posting payments, or issues with member accounts.
- Provided training for new employees on fundamental system functions, including posting payments, processing refunds, handling reversals and transfers, interpreting eligibility, and managing workflow.
Account Receivable Clerk
Affinity Health Plan
11.2019 - 10.2021
- Download payment spreadsheets for CHP, EP & IVR, as well as remote deposit/live checks and money orders.
- Deposit checks and money orders via JP Morgan Virtual Remittance.
- Post payments to member’s accounts.
- Verify member eligibility through Epaces, Facets, Payconnexion, or HBE tool.
- Respond to member inquiries about premiums, payments, gym rewards, or refunds in a timely manner.
- Verify and locate members from a weekly CAN’T ID list to post their payments.
- Work on open AR reports to verify if payment was received.
- Respond to emails through MAAR regarding refunds, posting payments, or issues with member accounts.
- Provided training for new employees on fundamental system functions, including posting payments, processing refunds, handling reversals and transfers, interpreting eligibility, and managing workflow.
Billing Specialist
General Vision Services/ Eyemart Express
04.2016 - 09.2018
- Verified accuracy of information on CMS 1500 forms prior to mailing paper claims.
- Ensured timely submission of claims via both electronic and mail channels.
- Managed large accounts including Davis Vision, Community Eye Care, and United Healthcare Services; maintained claim status every 15 to 30 days for payment.
- Contacted insurance providers to check patient eligibility for services if claims were unpaid.
- Established and maintained effective working relationships with store managers and employees to resolve payment issues, whether balance-related or reimbursement-related.
- Posted insurance payments to patients' accounts.
Billing Specialist
General Vision Services/ Eyemart Express
04.2016 - 09.2018
- Verified accuracy of information on CMS 1500 forms prior to mailing paper claims.
- Ensured timely submission of claims via both electronic and mail channels.
- Managed large accounts including Davis Vision, Community Eye Care, and United Healthcare Services; maintained claim status every 15 to 30 days for payment.
- Contacted insurance providers to check patient eligibility for services if claims were unpaid.
- Established and maintained effective working relationships with store managers and employees to resolve payment issues, whether balance-related or reimbursement-related.
- Posted insurance payments to patients' accounts.
Veterinary Receptionist
VET MY PET
06.2005 - 02.2009
- Processed medical forms for clients and prepared health certificates for pets.
- Recorded information on rabies tags for animals and managed client documentation.
- Guided clients on administering medication to their pets.
Veterinary Receptionist
VET MY PET
06.2005 - 02.2009
- Processed medical forms for clients and prepared health certificates for pets.
- Recorded information on rabies tags for animals and managed client documentation.
- Guided clients on administering medication to their pets.
Residential Counselor
Heritage Health & Housing
06.2001 - 12.2003
- Worked with mentally ill chemical abusers in a residential unit.
- Prepared folders with charts documenting clients' progress, background, and history.
- Assisted in NA & AA meetings.
- Accompanied clients to medical and psychiatric appointments.
Residential Counselor
Heritage Health & Housing
06.2001 - 12.2003
- Worked with mentally ill chemical abusers in a residential unit.
- Prepared folders with charts documenting clients' progress, background, and history.
- Assisted in NA & AA meetings.
- Accompanied clients to medical and psychiatric appointments.
Medical Biller (Internship)
Bronx Lebanon Medical Center
02.2001 - 12.2001
- Processed medical forms, recorded patients' insurance information, and made copies.
- Answered phones and performed multitasking duties with fax, email, and paperwork.
- Input client data into the computer mainframe.
Medical Biller (Internship)
Bronx Lebanon Medical Center
02.2001 - 12.2001
- Processed medical forms, recorded patients' insurance information, and made copies.
- Answered phones and performed multitasking duties with fax, email, and paperwork.
- Input client data into the computer mainframe.
Cashier/Waitress
Coconut Restaurant & Beer Garden
01.2000 - 01.2001
- Managed incoming and outgoing sales.
- Assisted customers with accurate order fulfillment.
- Trained new employees in cashier and waitress roles.
Cashier/Waitress
Coconut Restaurant & Beer Garden
01.2000 - 01.2001
- Managed incoming and outgoing sales.
- Assisted customers with accurate order fulfillment.
- Trained new employees in cashier and waitress roles.
Education
Bachelor of Science - Healthcare Administration with a concentration in Health Information Management
Southern New Hampshire University
04.2026
Associate's degree - allied health, Medical Billing & Coding Certificate
Sanford Brown Institute
New York, NY01.2015
Medical Assisting/Health Care Administration - undefined
New York, NY01.2013
High school diploma - undefined
James Monroe High School (Bronx Tech)
01.2002
Skills
- ICD-9 coding proficiency
- ICD-10 coding expertise
- CPT 4
- HCPCS
- Multi Phone Line System
- Insurance
- Billing
- Claim Entry
- Payment Posting
- Processing Electronic Claims
- Medicare
- Medicaid
- Tricare
- Insurance Reimbursement
- SimChart Software
- Electronic Medical Record
- Typing speed of 55 WPM
- HIPAA Compliance
- CMS 1500 FORM
Certification
New York State Certified Coding Specialist (NCCT), 2016-03-24
Additional Qualifications
- Certificate of Completion, renewed CPR, 2014
- Completed HIPAA training at Sanford Brown Institute
- Proofreading class completed, 1998
- Dean’s List at Sanford Brown Institute, 2014
- Dean's List at Southern New Hampshire University, 2025
- Fraud, waste, and abuse (FWA) experience encompasses the knowledge and skills needed to identify, prevent, and address fraudulent activities, inefficient practices, and misuses of resources. Understanding the differences between fraud, waste, and abuse, recognizing indicators of these issues, and knowing how to report them. I was also involved in implementing and maintaining effective internal controls to prevent FWA from occurring.
Personal Information
Title: Medical Billing and Coding Professional
Timeline
Team Lead Analyst, Premium Reconciliation & Billing
Affinity by Molina
10.2021 - Current
Team Lead Analyst, Premium Reconciliation & Billing
Affinity by Molina
10.2021 - Current
Account Receivable Clerk
Affinity Health Plan
11.2019 - 10.2021
Account Receivable Clerk
Affinity Health Plan
11.2019 - 10.2021
Billing Specialist
General Vision Services/ Eyemart Express
04.2016 - 09.2018
Billing Specialist
General Vision Services/ Eyemart Express
04.2016 - 09.2018
Veterinary Receptionist
VET MY PET
06.2005 - 02.2009
Veterinary Receptionist
VET MY PET
06.2005 - 02.2009
Residential Counselor
Heritage Health & Housing
06.2001 - 12.2003
Residential Counselor
Heritage Health & Housing
06.2001 - 12.2003
Medical Biller (Internship)
Bronx Lebanon Medical Center
02.2001 - 12.2001
Medical Biller (Internship)
Bronx Lebanon Medical Center
02.2001 - 12.2001
Cashier/Waitress
Coconut Restaurant & Beer Garden
01.2000 - 01.2001
Cashier/Waitress
Coconut Restaurant & Beer Garden
01.2000 - 01.2001
Associate's degree - allied health, Medical Billing & Coding Certificate
Sanford Brown Institute
Medical Assisting/Health Care Administration - undefined
High school diploma - undefined
James Monroe High School (Bronx Tech)
Bachelor of Science - Healthcare Administration with a concentration in Health Information Management
Southern New Hampshire University
Similar Profiles
Juana Mendez PaulinoJuana Mendez Paulino
Facility Enrolment Medicaid at Affinity By MolinaFacility Enrolment Medicaid at Affinity By Molina
Jennifer FernandezJennifer Fernandez
Senior Member Service Representative at Affinity By Molina HealthCareSenior Member Service Representative at Affinity By Molina HealthCare
MERA CARELAMERA CARELA
Marketplace Facilitated Enroller at Affinity by Molina Healthcare IncMarketplace Facilitated Enroller at Affinity by Molina Healthcare Inc
Yolande IrvineYolande Irvine
BSA AML Compliance Analyst/Bank Officer at Brookline BancorpBSA AML Compliance Analyst/Bank Officer at Brookline Bancorp
Xaviel HenriquezXaviel Henriquez
YPIE at Yonkers Partners In EducationYPIE at Yonkers Partners In Education