Open to opportunities

ishrath fatima

@ishrathfatima

Message

I am a claims processor and billing specialist focused on US healthcare claims, audits, and process improvement.

India

Message

What I'm looking for

I seek a US healthcare claims role where I can apply adjudication, billing and audit skills, drive process improvements, mentor colleagues, and work in a collaborative, metrics-driven environment with growth opportunities.

I am an experienced claims analyst specializing in US healthcare claims processing, billing and adjudication.

I have managed inpatient, outpatient and skilled nursing facility claims across Medicare, Medicaid and commercial payers, handling payments, denials, prompt-pay and high‑aged claims while preparing audit and end‑of‑day reports. I work with CIW, Reflection Workspace, M360, ACMP, WCF, GPOO, FileNet, Epic, Collaborate and Blue2.

I trained new joiners, supported restricted queues, and contributed to process improvements that improved accuracy and turnaround. Earlier in my career I increased sales penetration by 80% within two months and earned multiple performance awards. I prioritize HIPAA compliance, clear communication, and a metrics-driven approach to reduce rework and accelerate payments.

Experience

Work history, roles, and key accomplishments

Claims Processor Analyst

R4 Solution

Jun 2024 - Sep 2024 (3 months)

Processed US-based medical claims including payments and denials and performed pricing/allowed-amount lookups from Network X Price, GPOO and FileNet for pharmacy and specialty drug claims. Trained new joiners, produced end-of-day claim reports, and supported billing of professional claims using Collaborate and Epic while following HIPAA requirements.

Claims Processing Payments & Denials Pricing Allowed Amount Epic Collaboration HIPAA Training Audit Reporting

Claims Associate

Carelon Global Solutions

May 2020 - Feb 2024 (3 years 9 months)

Adjudicated inpatient, outpatient and skilled nursing facility claims including COB, Medicare, Medicaid, adjustments and corrected/void claims; managed prompt-pay and highly aged claims. Worked restricted queues and ITS claims (Blue2) and used CIW, Reflection Workspace, M360, ACMP, WCF and GPOO to resolve complex billing issues.

Medicare Medicaid Adjust Prompt Pay Reflection Work Space

Business Associate

Tata Consultancy Services

Jul 2017 - Oct 2019 (2 years 3 months)

Managed refund operations and investigated customer issues via email, recording payments, account information and call logs into systems while responding to customer requests. Supported domestic voice and non-voice processes, maintained documentation of medical records and coordinated escalations to meet SLAs.