Anahy Portillo

I’m a Medical Claims Examiner who reviews submitted medical claims for completeness and accuracy, ensuring required documentation is present and eligibility and coverage details are verified. I adjudicate claims using specific policy terms, medical-necessity guidelines, and established coding rules (CPT, ICD-10, and HCPCS).

Before my current role, I worked as a Medical Biller/Prior Authorization Specialist at Clinica Virgen De Guadalupe, where I ensured accurate claims information (patient data, diagnoses, and procedure codes) and submitted claims on time to primary, secondary, and tertiary payers. I also reviewed records, insurance policies, and provider requests to determine the need for prior authorization, educating patients and providers on the authorization process, requirements, and timelines.

I bring strong administrative and customer-facing support experience from a UEI College work-study role, including answering and directing incoming calls, entering information into databases, and maintaining organized workflows. I’m certified in medical billing coding, HIPPA, and CPR, and I’m committed to continuous improvement through training sessions, workshops, and staying current with industry standards and changes.