Summary
Overview
Work History
Education
Skills
Certification
Timeline
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Navida Abdul Nazar

Wesley Chapel,FL

Summary

Experienced Healthcare professional with over five years in medical coding, claims processing, healthcare quality analysis, and customer success operations. Demonstrated skills in client communication,reporting,coding policy interpretation, regulatory compliance, and process improvement. Proficient at researching and resolving coding discrepancies, ensuring compliance with federal, state, and payer guidelines, and collaborating with internal and external stakeholders. Skilled in PowerBI,SQL, JIRA Service Management, Smartsheet, Microsoft Project, Excel, and data security protocols.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Customer Success Operations Analyst

Avalon Healthcare Solutions
02.2023 - Current
  • Conduct in-depth analysis of customer workflows and operational data to identify trends and areas for improvement.
  • Utilize SQL to extract, analyze, and interpret provider and claims data to drive decision-making.
  • Manage ticketing systems in JIRA Service Management to streamline issue resolution.
  • Assist in process automation and reporting using Smartsheet, ensuring efficient project tracking and collaboration.
  • Work cross-functionally with teams to ensure compliance with internal policies, regulatory requirements, and industry best practices.
  • Remote

Healthcare Quality Analyst

Deloitte (Federal Subcontractor – Medical Disability Examination)
09.2022 - 02.2023
  • Conducted in-depth analysis of medical documentation and coding to ensure compliance with federal and state regulations.
  • Reviewed medical reports for coding accuracy, regulatory adherence, and legal compliance.
  • Provided recommendations to optimize documentation processes and improve accuracy.
  • Ensured strict adherence to PII/PHI security and privacy protocols.
  • Remote

Medical Claims Analyst

Envolve Dental
01.2021 - 09.2022
  • Reviewed and processed medical claims, ensuring compliance with payer policies and regulatory guidelines.
  • Researched and resolved provider coding disputes and appeals, verifying adherence to coding standards.
  • Provided recommendations to improve coding policies, reference materials, and internal claims processing procedures.
  • Collaborated with providers, internal teams, and payers to resolve coding and reimbursement discrepancies.
  • Assisted in policy modifications to enhance claims adjudication processes.

Healthcare Intern

Vaidya Ratnam Ayurveda College
10.2019 - 10.2020
  • Assisted in analyzing healthcare data to improve patient outcomes.
  • Supported the development and implementation of health programs focused on wellness and compliance.

Education

Bachelor’s - Healthcare Science

University of Kerala
05.2018

Skills

  • Medical Coding & Claims Processing (ICD-10, CPT, HCPCS)
  • SQL JIRA Service Management Smartsheet Microsoft Project Excel PowerPoint PowerBI
  • Healthcare Data Analysis & Reporting
  • Regulatory Compliance (State, Federal, Payer Guidelines)
  • Coding Policy Development & Process Improvement
  • Stakeholder & Provider Relationship Management
  • Critical Thinking & Problem-Solving
  • Verbal & Written Communication

Certification

Certified Professional Coder (CPC) | AAPC

Timeline

Customer Success Operations Analyst

Avalon Healthcare Solutions
02.2023 - Current

Healthcare Quality Analyst

Deloitte (Federal Subcontractor – Medical Disability Examination)
09.2022 - 02.2023

Medical Claims Analyst

Envolve Dental
01.2021 - 09.2022

Healthcare Intern

Vaidya Ratnam Ayurveda College
10.2019 - 10.2020

Bachelor’s - Healthcare Science

University of Kerala

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Navida Abdul Nazar