Anisha Hylton
@anishahylton
Healthcare claims and IDR specialist who delivers accurate, on-time reimbursement dispute resolutions.
United StatesWhat I'm looking for
I’m a detail-oriented healthcare professional specializing in Independent Dispute Resolution (IDR), claims and EOB analysis, and No Surprises Act (NSA) compliance. I manage high-volume caseloads while maintaining 98–100% quality assurance scores and meeting strict federal timelines.
I use the CMS IDR portal to submit, track, and manage arbitration cases, while verifying patient eligibility and benefits to ensure accurate claim adjudication. I’m known for strong analytical thinking and regulatory knowledge—communicating with providers, payers, and IDREs to resolve complex reimbursement disputes efficiently and identify payment discrepancies that support payment integrity and cost containment.
Experience
Work history, roles, and key accomplishments
Claims Adjudicator
Korak
Nov 2021 - Apr 2022 (5 months)
Reviewed and adjudicated medical claims according to policy, regulatory guidelines, and reimbursement standards, issuing accurate payment determinations. Identified and corrected underpayments and overpayments to improve payment accuracy and communicated with providers to resolve discrepancies.
Claims Specialist
The Jacobson Group
Dec 2019 - Sep 2020 (9 months)
Processed high-volume veterans insurance claims (up to 46 claims/day) with 98% accuracy by reviewing, adjusting, denying, and reprocessing as needed. Maintained detailed claim activity logs using Facets, OnBase, SharePoint, and Excel to support compliance and operational tracking.
Claims Specialist (Contract)
Operational Solutions & Technologies
Jan 2019 - May 2019 (4 months)
Supported NFIP claims processing by reviewing SALAE expenses for accuracy and compliance. Partnered with FEMA and insurance entities and produced audit-ready documentation and weekly status reports.
Education
Degrees, certifications, and relevant coursework
Western Governors University
Bachelor of Science in Information Technology Management, Information Technology Management
Pursuing a Bachelor of Science in Information Technology Management, expected to complete in December 2026.
Coastline Community College
Healthcare Management, Healthcare Management
Studied Healthcare Management at Coastline Community College in 2017.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
Interested in hiring Anisha?
You can contact Anisha and 90k+ other talented remote workers on Himalayas.
Message AnishaFind your dream job
Sign up now and join over 100,000 remote workers who receive personalized job alerts, curated job matches, and more for free!
