At ChangeHealthCare, I analyze insurance claims for accuracy, completeness, and eligibility as a Fraud Specialist 3. I review medical records and denial codes, request missing documentation, and send supported cases for medical review.
At UST Global, I worked on provider credentialing and claims projects for IBC, IUHP, and Relayhealth. My work included auditing claims, identifying errors, and supporting claim adjustments and clearinghouse services.
Earlier, at EXL SERVICES, I reviewed Workers’ Compensation medical bills and reconsideration appeals. I used medical reports and coding references to review bills, assign appropriate ICD-9 and CPT codes, and resolve coding-related claim issues.
I also worked as a Staff Nurse/Oncology Nurse at JORDAN HOSPITAL AND MEDICAL CENTER and as a Senior Staff Nurse at OUR LADY OF LOURDES HOSPITAL. My hospital experience included pediatric, oncology, and medical-surgical care, including administering chemotherapy drugs to cancer patients.
