Anthea Hau
Brooklyn,NY
Summary
Detail-oriented professional with expertise in claims processing and medical billing. Recognized for strong problem-solving skills and adaptability, driving process improvements to enhance operational efficiency.
Accomplished Claims Examiner and medical biller with over a decade of experience in the healthcare industry. Skilled in analyzing complex claims, mentoring teams, and fostering collaboration among stakeholders to improve claims processing efficiency and accuracy.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Quality Assurance Financial Auditor II
Healthfirst
Remote, NY
03.2025 - Current
- Review and investigate claims and encounters for medical, facility, pharmacy and vision services including contractual provisions, authorizations and Healthfirst policy and procedure.
- Participate as a Subject Matter Expert on various process improvement projects designed to meet departmental and operational needs.
- Assist management in preparing departmental reports policies and procedures.
- Assist with performing User Acceptance Testing (UAT) on system enhancements or corporate projects in partnership with Business Operationist.
- Analyze errors and determine root causes for appropriate classification.
Sr. Claims Examiner
Healthfirst
Remote, NY
03.2022 - 03.2025
- Reviewed and adjudicated complex claims to ensure compliance with policies and regulations.
- Collaborated with healthcare providers to resolve discrepancies and improve claims processing efficiency.
- Mentored junior examiners on best practices for claims evaluation and dispute resolution.
- Developed training materials to enhance team knowledge of claims management systems and procedures.
Operations Analyst
Healthfirst
Remote, NY
06.2021 - 03.2022
- Analyzed business processes, identify root causes and provide data-based insights and recommendations for process improvements.
- Received and responded to inquiries and complaints and interface with internal and external personnel.
- Participated in systems testing and validation for various operations systems.
- Assisted in the development of operational policies and procedures that aligned with organizational goals and objectives.
- Identified inefficiencies in current systems, recommending adjustments that resulted in increased productivity levels.
Claims Examiner
Healthfirst
Remote, NY
07.2012 - 06.2021
- Processed Medicare, Medicaid, DRG, APG, APC, Harp, Exchange, Inpatient/Outpatient, COB, FWA CLAIMSXTEN, COTIVITI, pharmacy and Correspondence work.
- Solved practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Reviewed, investigated and adjudicated claims and encounters for medical, facility, pharmacy, home health care, DME, hospice and vision services that involve the application of contractual provisions in accordance with provider contracts and authorizations.
- Meet individual and departmental standards with
regards to quality and productivity.
Claims Analyst
HealthPlus
Brooklyn, NY
11.2010 - 05.2012
- Analyzed and adjudicated pended claims generated from Facets.
- Collaborated with cross-functional teams to resolve complex claim issues efficiently.
- Reviewed and processed all LOBs claims accurately, ensuring timely payments to providers and members.
- Analyzed claims to determine appropriate, reimbursement for par or non-par providers.
- Documented & track claim inquiries using Customer Focus.
Medical Biller
VA Medical Center
Brooklyn, NY
08.2009 - 11.2010
- Submitted & followed up pharmacy bills and ePharmacy claims.
- Reviewed and corrected billing discrepancies to maintain compliance with federal regulations.
- Verified insurance & processed In-patient admission.
- Reviewed patient records, identified medical codes and created invoices for billing purposes.
Medical Biller
St. Luke's Roosevelt Hospital
New York, NY
11.2008 - 08.2009
- Billed Medicare, Medicaid & other 3rd party payers.
- Posted patients and third-party payments to accounts.
- Submitted Workers Compensations Claims.
- Verified patient's insurance, Obtained current insurance/authorization updates and Scheduled appointments and answered billing questions.
- Coded physician encounter forms.
Medical Biller
NYU Hospital for Joint Disease
New York, NY
09.2006 - 09.2008
- Billed Medicare, Medicaid & other 3rd party payers and posted third-party payments to accounts.
- Communicated with insurance providers to resolve denied claims and resubmitted claims.
- Coded physician encounter forms and prepared billing statements for patients and verified correct diagnostic coding.
- Handled referrals and pre-authorization.
- Registered patient, verified insurance, Collected payments.
- Resolved patient billing problems and complaints.
Education
GED -
College of Staten Island
Staten Island, NY03-2003
Skills
- Attention to detail
- Customer service
- Multitasking Abilities
- Problem-solving abilities
- Adaptability and flexibility
- Self motivation
- Interpersonal skills
- Goal setting
- Staff training
- Task prioritization
Certification
- Certificate of ICD-9, NYU Langone Medical Center-2008
- Certificate of Medical Terminology, NYU Langone Medical Center -2008
Languages
Chinese (Cantonese)
Chinese (Mandarin)
Timeline
Quality Assurance Financial Auditor II
Healthfirst
03.2025 - Current
Sr. Claims Examiner
Healthfirst
03.2022 - 03.2025
Operations Analyst
Healthfirst
06.2021 - 03.2022
Claims Examiner
Healthfirst
07.2012 - 06.2021
Claims Analyst
HealthPlus
11.2010 - 05.2012
Medical Biller
VA Medical Center
08.2009 - 11.2010
Medical Biller
St. Luke's Roosevelt Hospital
11.2008 - 08.2009
Medical Biller
NYU Hospital for Joint Disease
09.2006 - 09.2008
GED -
College of Staten Island