Wadii Nistas

• Ensured accurate, compliant billing for Government Programs, Commercial Health Plans, and Medical Group payers.
  • Monitored claim status, collaborated with payers, and resolved issues to ensure timely payment.
  • Coordinated payer authorizations, expedited claim approvals by verifying forms and documentation.
  • Validated coding, billing units, and payer requirements to minimize claim rejections and streamline reimbursement.
  • Managed revenue recognition, ensuring billing followed contractually agreed rates and was accurately recorded.
  • Analyzed and corrected billing discrepancies to align payments with contractual agreements, preventing revenue loss.
  • Collaborated with internal teams to address reimbursement challenges and implement process improvements.
  • Escalated complex issues to management for swift resolution, minimizing operational delays.
  • Handled payer and patient inquiries, maintaining strong customer relationships during collection efforts.

• Demonstrated multitasking skills by prioritizing tasks and meeting deadlines in a fast-paced environment.
• Adhered to HIPAA regulations, ensuring patient privacy and confidentiality.

• Reviewed and processed pre-authorization requests, ensuring compliance with insurance guidelines.
• Verified patient eligibility and benefits coverage to determine pre-authorization requirements.
• Collaborated with healthcare providers to obtain necessary documentation for approvals.
• Communicated with insurance companies to resolve pending or denied requests.
• Maintained accurate records of pre-authorization activities in the database.
• Managed a high volume of calls from patients, providers, and insurance reps.
• Ensured timely submission of pre-authorizations and adhered to HIPAA regulations.

• Provided claims support during the claim file process and Communicated and collaborated with adjusters.
• Researched, obtained, and documented claim information.
• Processed claim tasks to include loss/expense payments within authority and correspondence Processed financial transactions within guidelines (e.g., stop pays, reissues; payment transfers, etc.) Managed claim file maintenance to include closings, transfers, splits, claim file audit pulls, etc.

• Verified patient eligibility and benefits prior to claim submission.
Assisted in developing and implementing process improvements for claims workflow efficiency.
• Ensured timely resolution of outstanding claims by following up with payers.
• Collaborated with cross-functional teams to resolve complex claim issues.
Maintained strong relationships with insurance companies to ensure timely reimbursement.
• Participated in meetings to discuss process improvements and operational challenges.
• Investigated and resolved complex claim issues through analysis of records and policy documents.

• Advised MassHealth members and providers on benefits, claims resolution,pharmacy issues, and eligibility
• Enrolled members into health plans and resolved premium billing issues, enhancing member satisfaction

• Processed and maintained complex claims files, ensuring accuracy in financial transactions and loss/expense payments
• Assisted with special projects, providing key insights and supporting claims process enhancements

• Processed life benefits claims with accuracy and timeliness, collaborating closely with clients, brokers, and legal teams
• Managed fraud investigations and beneficiary changes, streamlining communications and claims resolution