
Eric Galan
@ericgalan
Clinical reviewer at Optum/United Health Group reviewing medical claims, identifying billing errors, and maintaining 98% accuracy.
What I'm looking for
At Optum/United Health Group, I review medical claims, investigate billing patterns, and recommend payment approval or denial based on clinical findings. I maintain a minimum accuracy rate of 98% while following CMS and client guidelines.
At MCS Healthcare Holdings, LLC, I coded and analyzed clinical information from medical records and claims using ICD-10-CM. I hold CPC and CRC certifications and have also worked in medical claims data entry and as a physician assistant.
Experience
Work history, roles, and key accomplishments
Clinical Reviewer
Optum/United Health Group
Jan 2025 - Present (1 year 9 months)
Investigated and reviewed medical claims with identifiable billing patterns, issuing recommendations for payment approval or denial based on clinical findings. Collaborated with analytics team to develop strategies that maximized savings and maintained a minimum accuracy rate of 98%.
Risk Adjustment Coder
MCS Healthcare Holdings, LLC
Jan 2024 - Jan 2025 (1 year)
Performed coding and analysis of clinical information from inpatient and outpatient medical records to assign accurate ICD-10-CM diagnosis and procedure codes. Served as liaison between risk evaluation unit, providers, and billing departments to ensure consistent code assignment.
Data Entry Analyst
First Medical Health Plan, Inc
Jan 2024 - Dec 2024 (11 months)
Received, sorted, and entered data from paper medical claims. Prepared paper claims for digitization and returned non-processable claims to providers for correction.
Physician Assistant
Doctors' Center Hospital
Jan 2014 - Dec 2018 (4 years 11 months)
Provided clinical support and assistance to physicians in a hospital setting.
Education
Degrees, certifications, and relevant coursework
American Academy of Professional Coders (AAPC)
Certified Professional Coder (CPC), Medical Coding
Earned the Certified Professional Coder (CPC) certification in 2025.
Advance Learning Center, Inc.
Risk Adjustment Coding Course, Medical Coding
Completed a Risk Adjustment Coding Course preparing for AAPC CRC certification, including Payment Methodologies and ICD-10-CM Coding.
Asociación de Facturadores Médicos de Puerto Rico (AFAMEP)
Medical Billing and Coding, Medical Billing and Coding
Completed training in Medical Billing and Coding and Electronic Medical Billing.
American Academy of Professional Coders (AAPC)
Certified Risk Adjustment Coder (CRC), Risk Adjustment Coding
Earned the Certified Risk Adjustment Coder (CRC) certification in 2024.
University of Medicine Health & Science
Incomplete, Biomedical Sciences
2018 - 2020
Pursued studies in Biomedical Sciences from 2018 to 2020, but did not complete the program.
Interamerican University
Bachelor's, Biomedical Sciences
Completed a Bachelor's in Biomedical Sciences at Interamerican University in 2018.
Tech stack
Software and tools used professionally
Availability
Location
Authorized to work in
Salary expectations
Job categories
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