Open To Work
Nicole L. Misa
NYIR
Kissimmee,FL
Work Preference
Job Search Status:
Open to work
Desired Job Title
Healthcare Data AnalystFinancial AnalystMedical Office ManagerBilling ManagerPrior Authorization Coordinator
Work Type
Full Time
Location Preference
Remote
Minimum Desired Compensation
$32/hr
Important To Me
Company CulturePersonal development programsHealthcare benefitsWork from home option401k matchPaid time offCareer advancement
1
Language
1
Certification
20
Years of experience
Managed revenue and reimbursement analysis in healthcare finance, using financial insights to guide compliance priorities and business decisions. Trained office staff to keep communication clear and workflows accurate and efficient to ensure smooth daily operations. Reduced denial activity, supported revenue growth, and updated procedures as healthcare requirements changed.
Work History
Sr. Reimbursement Analyst
10 Years- Tracked denial patterns and managed appeal preparation workflow for contested claims.
- Coordinated office staff workflow for proper insurance verifications and patient-specific coverage assessment, including insurance coverage rules, referral requirements, and out-of-pocket cost calculations to maintain smooth operations and customer satisfaction.
- Maintained up-to-date knowledge of regulatory changes affecting reimbursements and proactively adapted processes accordingly.
- Interpreted payer contracts to ensure accurate fee schedules and coverage rules, enhancing reimbursement accuracy.
- Coordinated patient account management and collections support, contributing to 10–12% revenue recovery growth.
Clinical Practice Plan Representative
1 Year 8 Months- Managed daily work queues, prioritized workload, and improved consistency across front office operations.
- Maintained insurance and patient aging records, overseeing resubmission of outstanding claims to support timely resolution.
- Handled monthly patient statements and billing inquiries by researching concerns and delivering accurate responses.
- Provided excellent service and troubleshot issues to strengthen customer experience and satisfaction.
Medical Billing Specialist
5 Years 7 Months- Acted as key liaison across front office, clinical staff, and insurance providers to facilitate clean claims, accurate coding, and timely reimbursement.
- Verified insurance eligibility for 125+ patients each day to support accurate scheduling and reduce eligibility errors.
- Conducted insurance verifications and coded medical procedures for pre-authorizations while maintaining patient charts to ensure accurate billing.
- Resolved denied claims through strategic communication with insurance providers, facilitating resubmission for timely reimbursement.
- Evaluated insurance policies to clarify coverage limits and patient financial responsibilities, enhancing billing accuracy.
Education
High School Diploma
Certified Medical Assistant - Healthcare Administration & Medical Assistant
Skills
Accurate billing and account processing resulted from support within revenue cycle operations.
Stronger follow-up on unresolved claims resulted from denial management activity.
Improved case review and escalation support resulted from appeals handling.
Reduced coverage uncertainty during processing resulted from insurance policy validation.
Timely claim and payment activity resulted from medical billing work.
Clearer visibility into account status resulted from financial reporting.
Better daily problem resolution resulted from analytical thinking.
Stronger reporting and data organization resulted from advanced Excel techniques.
Improved workflow accuracy and analysis resulted from Excel functions.
Positive service experiences resulted from customer relations support.
Appropriate case processing resulted from utilization review work.
Confidential patient information remained protected through HIPAA compliance.
Greater administrative efficiency resulted from Microsoft Office proficiency.
Compliant claim handling resulted from Medicare knowledge.
Compliant claim handling resulted from Medicaid knowledge.
Accurate benefit processing resulted from commercial insurance knowledge.
Correct documentation and billing resulted from ICD-10 coding knowledge.
Productive remote work resulted from telecommuting processes.
Accomplishments
Reduced claim processing errors by 25% for over 600 monthly accounts through creating and tracking checklists and cross-referencing constantly evolving insurance payer guidelines.
Certification
HIPAA Compliance Training, ICD-10-CM/PCS Training, Medicare & Medicaid Billing Training
Languages
English
Native or Bilingual
AWARDS & SCHOLARSHIPS
Customer Service Excellence Award
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Sr. Reimbursement Analyst
NYIR
10.2016 - CurrentRead More
Clinical Practice Plan Representative
NSLIJ
07.2012 - 03.2014Read More
Medical Billing Specialist
Long Island & Queens Vitreo Retinal Consultants
11.2006 - 06.2012Read More
NEW AGE TRAINING, INC.
Certified Medical Assistant from Healthcare Administration & Medical Assistant
Read More
Farmingdale Senior High School
High School Diploma
Read More