Faisal Rahmani

I’m a Detail-oriented Healthcare Configuration Specialist with experience supporting claims system configuration, claims codes, benefit plan setup, provider data, eligibility rules, fee schedules, authorization requirements, and claims processing workflows.

I maintain CPT, HCPCS, ICD diagnosis codes, revenue codes, modifiers, provider records, payer rules, claim edits, and reimbursement logic, and I troubleshoot claim denials, payment issues, eligibility mismatches, and configuration defects across claims, operations, IT, and business teams. I’m experienced in testing, documentation, data validation, issue resolution, and healthcare compliance standards with HIPAA/PHI awareness.

In my current role at Apex, I configure and maintain healthcare claims system data—CPT codes, HCPCS codes, ICD diagnosis codes, revenue codes, modifiers, place of service codes, provider records, member eligibility, and plan benefit rules. I review and update configuration tables, validate claims setup with test claims and expected outcomes, and reduce claim errors, manual rework, payment delays, and downstream reporting issues through configuration quality checks.

Previously at Akkenna (Claims / PDR Specialist), I processed PDR claims, reviewed claim details for accuracy, and analyzed claims error codes and denial reasons to identify root causes and required corrections. I also validated member, provider, procedure codes, diagnosis codes, and supporting documentation, using Excel and system tools to track issues and compare expected versus actual results, and I earned a Bachelor’s Degree in Information Technology from Kabul University.