Satirrah Freeman

Configured and maintained provider pricing agreements, ensuring strict compliance with CMS regulations and translating medical policies into actionable reimbursement rules. Analyzed CPT/HCPCS codes for fee schedules and conducted root cause analysis to resolve claim suspensions and improve pricing accuracy. Audited claims to verify correct coding, reimbursement rates, and ensured provider payments

Led provider data management initiatives, overseeing additions, terminations, and updates to ensure accurate and up-to-date network information. Analyzed performance metrics and workflows to drive operational efficiency and process improvements. Utilized SQL and Access to generate comprehensive, data-driven reports that informed process optimization and decision-making.

Processed and adjudicated healthcare claims, ensuring accuracy and compliance with company policies and regulatory requirements. Tracked and audited healthcare claims to identify discrepancies, resolve provider issues, and maintain accurate financial records. Resolved provider grievances, maintained detailed issue logs for tracking, and implemented process improvements to enhance efficiency.

Addressed provider and member inquiries regarding claims, benefits, authorizations, reimbursements, and medication-related issues, ensuring timely and accurate resolutions. Educated providers on policies, procedures, and system updates while assisting members with enrollment, eligibility, and coverage concerns. Managed high-volume inbound calls, documented interactions, and escalated complex issue

Completed high school education, earning a High School Diploma.

Completed prerequisites for the Pre-Nursing Program, focusing on foundational coursework relevant to nursing studies.