Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Tiesha Arjoon

Bronx,NY

Summary

Professional in healthcare claims processing with strong background in medical billing and coding. Proven ability to streamline workflows, resolve complex claims issues, and maintain compliance with industry standards. Known for effective collaboration, adaptability, and consistently achieving high productivity levels. Skilled in navigating insurance policies, managing patient information, and utilizing claims management software.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Hospital Claims Processor V - Temp

1199SEIU Fund (Vanguard Staffing)
12.2024 - Current
  • Claims Processing:
  • Review and process hospital claims for inpatient and outpatient services, ensuring accuracy and compliance with relevant payer guidelines.
  • Utilize ICD-10, CPT, and HCPCS coding systems to validate codes used in claims submissions.
  • Review EOB to determine Coordination of benefits.
  • Claims Auditing:
  • Perform comprehensive audits of claims to identify discrepancies, errors, or trends that may affect reimbursement.
  • Preauthorization Management:
  • Manage the preauthorization process, verifying that necessary approvals are obtained un accordance to laws and statues.

Medical Billing Analyst - Temp

Samaritan Daytop Village (Tandym Group)
09.2024 - 12.2024
  • Claims Preparation and Submission:
  • Accurately prepared and submitted claims for services rendered at the substance abuse facility, including outpatient and inpatient treatments, assessments, and therapeutic services.
  • Utilized appropriate coding systems (ICD-10, CPT, HCPCS) to ensure claims are submitted in compliance with payer requirements and regulatory standards.
  • Payer Verification:
  • Verified patient insurance coverage and benefits for substance abuse treatment services prior to admission and during the billing process.
  • Coordinated with insurance companies to clarify coverage and obtain pre-authorizations for necessary treatment services.
  • Claims Auditing and Denial Management:
  • Reviewed submitted claims for accuracy and completeness, auditing for errors or discrepancies that may lead to denials.
  • Investigated and resolve denied claims, preparing appeals and providing supporting documentation as necessary to ensure timely payment.
  • Documentation and Compliance:
  • Ensured that all documentation related to claims processing is maintained in accordance with HIPAA regulations and internal policies.
  • Stayed updated on changes to billing regulations, payer policies, and compliance requirements specific to substance abuse treatment.

Financial Representative

Northwestern Mutual
01.2024 - 07.2024
  • Client Consultation:
  • Met with clients to understand their financial goals, needs, and concerns, conducting thorough financial assessments to determine suitable solutions.
  • Educated clients on various financial products, including investment options, insurance policies, retirement plans, and estate planning.
  • Financial Planning:
  • Developed customized financial plans based on clients’ objectives, risk tolerance, and financial situations.
  • Analyzed clients' investment portfolios, recommending adjustments as needed to optimize performance and alignment with their goals.
  • Product Knowledge:
  • Stayed informed about a wide range of financial products and services, including stocks, bonds, mutual funds, life insurance, annuities, and retirement plans.
  • Maintained knowledge of industry trends, market conditions, and regulatory changes to provide accurate and up-to-date information to clients.
  • Investment Management:
  • Assisted clients in making informed investment decisions by providing recommendations based on market analysis and financial research.
  • Monitored and reviewed investment performance regularly, adjusting strategies to align with changes in clients’ financial goals or market conditions.
  • Client Relationship Management:
  • Build and maintained strong relationships with clients through regular communication, follow-ups, and personalized service.
  • Proactively addressed clients’ inquiries and concerns, providing exceptional customer service and fostering long-term trust.
  • Sales and Marketing:
  • Developed and implement strategies to attract new clients and retain existing ones, utilizing networking, referrals, and marketing efforts.
  • Conducted presentations and seminars to educate potential clients about financial planning and investment opportunities.
  • Compliance and Documentation:
  • Ensured compliance with financial regulations and industry standards, maintaining accurate and complete records of client interactions and transactions.
  • Prepared and presented financial documentation, reports, and proposals as needed for client meetings.

Claims Processor

Affinity Health Plan
01.2020 - 01.2023
  • Performed medical billing and adjustments for claims.
  • Assisted members, physicians and hospitals with queries and concerns on accounts.
  • Navigated through various databases and programs for updating and maintenance daily.
  • Daily follow-up on claims and correspondence.
  • Provided information to members on various benefit insurance packages offered.
  • Provided ICD-10 and diagnostic codes for claims and medical procedures.
  • Maintained, correlated and prepared medical records and files of members.

Member Services Representative -Temp

Dow Jones (Bartech Group)
03.2018 - 09.2018
  • Maintained a high degree of customer service for all support queries and adhered to all service management principles and service level agreements.
  • Provided excellent customer service to customers in a courteous, effective and timely manner to ensure resolution of customer contacts.
  • Made independent decisions to resolve customer issues with strong problem solving and negotiation skills.
  • Partnered with other departments to ensure escalated issues were handled timely and correctly.
  • Owned customer cases by being the named case manager bringing the case to final conclusion.
  • Provided technical support to customers experiencing issues with their digital subscription.

Claims Compliance Auditor

ERN/The Reimbursement Advocacy Firm, LLC
06.2017 - 11.2017
  • Evaluated the adjudication of claims using standard principles and state specific policies and regulations.
  • Identified incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and other errors in processing of claims.
  • Ensured compliance with regulations and controls by examining records, reports, operating practices, and documentation: made recommendations to strengthen internal control structure.
  • Communicated audit progress and findings through preparation of management reports.
  • Reviewed timeliness of claims processing to ensure a match to contractual and Federal requirements.
  • Developed and presented recommendations for improvements to management based off of audit findings and results.
  • Supported external auditors by collecting and coordinating information requirements.
  • Enhanced compliance department and organization reputation by accepting ownership for accomplishing new and different requests and for taking on stretch objectives.

Inquiry Resolution Specialist -Temp

Conifer (Health Care Scouts)
03.2017 - 05.2017
  • Researched and compiled information based on medical records and state standards to provide accurate inquiry resolutions.
  • Exceeded expectations by providing in depth information to customers regarding account status to develop satisfactory resolution plans.
  • Utilized Mainframe system to ensure activities were documented properly for company transparency and in accordance to company's policy standards.
  • Built trusted customer relationships by providing the highest level of customer service to clients.

Medical Biller -Temp

Coastal Dermatology and Plastic Surgery
07.2016 - 10.2016
  • Verified patient eligibility and benefits before services rendered to ensure customer satisfaction and to eliminate future collection accounts.
  • Maintained communication with insurance companies on aged balances and reimbursement discrepancies for payment resolution escalating to appeals when necessary.
  • Analyzed Pathology chart coding utilizing ICD-10 and CPT guidelines to ensure clean claims were being processed.

Medical Billing Extern Student

Sunrise Multispecialty Urgent Care
04.2016 - 05.2016
  • Analyzed medical records and abstracted procedures and diagnoses to assign appropriate ICD-10, CPT and HCPCS Codes to ensure clean claims were processed for proper reimbursement.
  • Audited charts examining if appropriate ICD-10 and CPT codes correlated with the services rendered to ensure compliance to state laws and regulations.
  • Retrieved information from S.O.A.P notes in order to code and process health insurance claim forms.
  • Assured that re-bills were processed correctly and denial issues were resolved promptly ensuring aged reports and backlogs were addressed and updated to reflect current status.
  • Processed cash and insurance payments ensuring proper revenue management.
  • Communicated with insurance companies regarding incorrectly reimbursed claims and escalated appeals when denials or partial payment were issued.

Asset Protection Detective

Saks Fifth Avenue
10.2014 - 12.2014
  • Conducted daily floor, building, and cash audits in order to minimize and deter company loss resulting in savings of over $1 million dollars.
  • Conducted data gathering and analysis using Mainframe and other data tracking systems to combat fraud related transactions directly leading to savings of more than $500,000 dollars.
  • Prevented internal theft by running and analyzing employee production reports and identifying discrepancies; partnered with corporate asset protection group to take disciplinary action and, where appropriate, made recommendations for prosecution.
  • Supervised 40 employees focusing on loss awareness and building procedures in high volume sales and traffic departments.
  • Responsible for training new hire employees on loss awareness and customer awareness protocols.
  • Conducted weekly department meeting focused on introducing and implementing programs and/or systems to effectively tackle company loss.
  • Acted as a liaison for the executive staff on any technical or hazardous issues to foster a safe and functional work environment.

Education

College Diploma - Medical Billing and Coding Program

American Career College
Anaheim, CA
01.2016

Skills

  • Medicaid/Medicare
  • Commercial Insurance
  • Medical Office Experience
  • Revenue Cycle Management
  • Data entry
  • Medical Billing
  • ICD-9/ICD-10
  • CPT coding
  • Medical Terminology
  • HIPAA compliance
  • Claim denials management
  • HIPAA
  • Electronic health records (EHR)
  • Claims investigation
  • Microsoft office
  • Documentation skills
  • Reporting skills
  • Prior authorization processing
  • Policy review
  • Coverage determination
  • Insurance coverage verification
  • Eligibility determination

Certification

  • Medical Billing and Coding Certification
  • May 2016 to Present
  • Obtained medical billing and Coding certification
  • Life & Health Insurance License
  • July 2023 to July 2025

Timeline

Hospital Claims Processor V - Temp

1199SEIU Fund (Vanguard Staffing)
12.2024 - Current

Medical Billing Analyst - Temp

Samaritan Daytop Village (Tandym Group)
09.2024 - 12.2024

Financial Representative

Northwestern Mutual
01.2024 - 07.2024

Claims Processor

Affinity Health Plan
01.2020 - 01.2023

Member Services Representative -Temp

Dow Jones (Bartech Group)
03.2018 - 09.2018

Claims Compliance Auditor

ERN/The Reimbursement Advocacy Firm, LLC
06.2017 - 11.2017

Inquiry Resolution Specialist -Temp

Conifer (Health Care Scouts)
03.2017 - 05.2017

Medical Biller -Temp

Coastal Dermatology and Plastic Surgery
07.2016 - 10.2016

Medical Billing Extern Student

Sunrise Multispecialty Urgent Care
04.2016 - 05.2016

Asset Protection Detective

Saks Fifth Avenue
10.2014 - 12.2014

College Diploma - Medical Billing and Coding Program

American Career College

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