Natasha Coleman
Katy,TX
Summary
Healthcare Operations and Claims Professional with over 10 years of experience specializing in medical billing, claims processing, compliance audits, and eligibility verification. With a proven ability to resolve complex claims issues, support escalations, train new employees, and maintain strict HIPAA compliance. Currently pursuing a Bachelor of Science in Healthcare Administration with a focus on healthcare operations leadership.
Overview
10
10
years of professional experience
Work History
Needs Coordinator
Health Admins
01.2025 - Current
- Review and process medical claims submitted by members and providers while ensuring accuracy, completeness, and compliance with MCS guidelines.
- Investigate and resolve claim discrepancies, billing issues, and escalated claims matters in a timely and professional manner.
- Conduct comprehensive medical claims audits to identify errors, inconsistencies, and potentially fraudulent activity.
- Research complex medical billing and coding issues involving ICD-10, CPT, and HCPCS codes.
- Collaborate with internal departments, providers, and members to ensure accurate claims resolution and positive customer outcomes.
- Assist with training and mentoring new employees on claims processing procedures and workflows.
- Serve as a point of contact for major groups and assist with resolving high priority claims concerns.
- Maintain productivity and quality standards in a high-volume remote healthcare environment.
- Conducted data analysis to identify trends and support decision-making processes for management.
Medical Claims Processor
Elevance
02.2023 - 11.2024
- Analyzed and processed incoming medical claims from healthcare providers and patients.
- Verified claims accuracy, coding, insurance coverage, and eligibility information.
- Assessed claims for approval, denial, or further review based on policy guidelines and reimbursement criteria.
- Investigated denied rejected claims and initiated appeals when appropriate.
- Calculated reimbursement according to contracts, fee schedules, and patient benefits.
- Ensured compliance with HIPAA regulations and healthcare policies.
- Assisted with resolving complex claims and escalated issues.
- Reviewed and resolved discrepancies in claims submissions to enhance processing efficiency.
- Collaborated with healthcare providers to gather necessary documentation for claim approvals.
Medical Claim Specialist
Teleperformance
08.2020 - 02.2023
- Handled inbound calls, emails, and chat regarding healthcare claims, benefits, and coverage.
- Assisted members with understanding EOB statements and claims status.
- Investigated and resolved claims discrepancies and denied claims issues.
- Coordinated with healthcare providers and insurance companies to resolve claims concerns.
- Utilized strong de-escalation and problem-solving skills to resolve customer and provider concerns.
- Reviewed claim submissions to identify discrepancies and ensured timely resolution of issues.
- Collaborated with healthcare providers to gather documentation supporting claim approvals.
Eligibility Specialist
Molina Healthcare
08.2016 - 08.2020
- Managed high-volume inbound calls regarding Medicaid eligibility and coverage.
- Verified applicant information according to state and federal Medicaid guidelines.
- Assisted applicants with Medicaid applications, renewals, and eligibility requirements.
- Provided accurate information regarding benefits, deadlines, and coverage options.
- Maintained confidentiality and compliance with healthcare privacy regulations.
- Assessed eligibility for healthcare programs, ensuring compliance with regulations and policies.
Education
Bachelor of Science - Healthcare Administration
University of Phoenix
Phoenix, AZ01-2027
Medical Billing And Coding -
University of Phoenix
Tempe, AZ06-2024
High School Diploma -
Elsik High School
Houston05-2021
Skills
- Medical Claims Processing
- Claims Auditing
- Revenue Cycle Management
- Claims Resolution
- Cross-Functional Operations
- De-Escalation Techniques
- Provider Relations
- Fraud & Discrepancy Investigation
- Training and Onboarding
- Remote Operations
- Data Entry & Documentation
- Payment Posting
- Insurance Verification
- HIPAA Compliance
- EOB Analysis
- EHR Systems
- Data entry
- Relationship building
Timeline
Needs Coordinator
Health Admins
01.2025 - Current
Medical Claims Processor
Elevance
02.2023 - 11.2024
Medical Claim Specialist
Teleperformance
08.2020 - 02.2023
Eligibility Specialist
Molina Healthcare
08.2016 - 08.2020
Bachelor of Science - Healthcare Administration
University of Phoenix
Medical Billing And Coding -
University of Phoenix
High School Diploma -
Elsik High School