You will get expert medical claim reviews for compliance & accuracy
Project details
You will receive a thorough and professional review of your medical claims, with a focus on accuracy, compliance, and maximizing reimbursement. With over 9 years of experience in healthcare QA and nursing, I specialize in insurance claim appeals, denial management, and chart audits for home health and skilled nursing facilities. I'm a HIPAA-certified expert in Medicare and CMS guidelines, delivering results that reduce errors, speed up approvals, and improve revenue cycle outcomes. My process is detail-driven, confidential, and built for healthcare providers who value precision.
Data Entry Type
Document Conversion, Error Detection, Online Research, Word ProcessingData Entry Tool
Google Docs, Google Sheets, Medical Records Software, Microsoft Excel, Microsoft Office, Microsoft WordWhat's included $100
These options are included with the project scope.
$100
- Delivery Time 2 days
- Number of Revisions 1
- Number of Hours of Work 8
- Formatting & Clean Up
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Tiantian Z.
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About Roxanne
Virtual Assistant | Insurance Utilization Expert | Medical Claims
Cabanatuan City, Philippines - 3:36 am local time
Key Skills:
1. Medical Claims Review: Ensuring accuracy and justifiable charges for insurance claims.
2. Regulatory Compliance: Verifying claims adhere to industry and government standards.
3. Process Optimization: Enhancing claim processing workflows, including submitting disputes and rebuttals to ensure fair claim resolutions.
4. Attention to Detail & Analytical Skills: Assessing medical necessity and appropriateness of charges for each case.
Professional Experience:
1. Good Samaritan Medical Center, Cabanatuan City: Managed the medical conditions of up to 20-30 patients daily while developing and implementing a rotational system for patient care.
Recognized for dedication, ambition, and ability to work autonomously.
2. Royal Majesty Home Health: Currently serving as a QA Chart Auditor, responsible for ensuring compliance with regulatory standards and organizational policies through audits, clinical practice evaluations, and documentation monitoring. Collaborate with interdisciplinary teams to develop improvement plans and provide training on quality assurance and compliance best practices.
3. MDA, Cabanatuan City: In my role as an RN Medical Chart Auditor, I review and research medical records to ensure accuracy in coding, billing, and clinical documentation. Adhere to productivity requirements, protect sensitive information, and contribute to team efforts in achieving departmental goals.
Education:
Master's Degree in Nursing
Location:
Nueva Ecija, Philippines
Let's Connect:
I am eager to bring my expertise in medical claims review and insurance utilization management to your organization. Let's discuss how my skills can contribute to your success.
Steps for completing your project
After purchasing the project, send requirements so Roxanne can start the project.
Delivery time starts when Roxanne receives requirements from you.
Roxanne works on your project following the steps below.
Revisions may occur after the delivery date.
document gathering
Review client’s submitted medical claims and supporting documentation.
Data Analysis
Analyze claims for coding accuracy, denial reasons, and CMS compliance.