Zoey Hageru

[email protected] 202-556-1564
LinkedIn: linkedin.com/in/yonatantussa/ GitHub: github.com/yonatantussa

PROFESSIONAL SUMMARY

Results-driven Claims Specialist with over 3 years of experience in medical billing and claims processing. Proven track record of improving claims accuracy by 15% and reducing claim denials by 20% through meticulous documentation review and coding verification. Adept at navigating complex healthcare regulations and payer policies to ensure compliance and expedite reimbursement cycles. Skilled in utilizing advanced claims processing platforms and EHR systems to streamline workflows and enhance operational efficiency. Committed to delivering high-quality support that optimizes revenue cycle management and fosters positive provider relationships.

WORK EXPERIENCE

Claim Review Specialist
02/2023 - Present
Aetna – Health Operations , Remote
Reviewed and adjudicated large volumes of medical claims with consistent 98% accuracy, ensuring alignment with payer policies and regulatory requirements
Communicated with providers to resolve documentation gaps and coding discrepancies, completing 90%+ of inquiries within SLA
Assessed ICD, CPT, and HCPCS coding to prevent recurring errors and reduce manual rework
Coordinated with internal teams to improve routing and processing efficiency across departmental workflows
Maintained benchmark productivity and compliance metrics in a high-demand claims environment

EDUCATION

[Your Degree]
[Month Year]
[Your School Name] , [City, State]

SKILLS

PROJECTS

Claims Quality Optimization
Technologies: Claims Tools, Documentation Review
Analyzed frequent denial patterns for high-volume claim types and implemented a revised documentation checklist that improved initial-pass claim accuracy

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