Quality Analyst at Med-Metrix (2025-05 – Present)
- Quality Auditing: Developed Quality Parameters for 100% audit coverage, ensuring strict adherence to HIPAA regulations and Standard Operating Procedure.
- Process Optimization: Architected a comprehensive Standard Operating Procedure (SOP) Playbook, standardizing workflows across two major accounts to reduce onboarding time and human error.
- Data-Driven Trends & Allocation: Partnered with Operations management to analyze quality gaps, co-designing workflow game plans and task allocation strategies that boosted overall team productivity by 15%.
- Crisis Management & Account Stabilization: Intervened during an unexpected team leadership transition to stabilize a critical healthcare account, successfully mitigating client escalations and resolving severe productivity bottlenecks.
- Cross-Functional Training Support: Addressed critical training department staffing shortages by independently facilitating technical onboarding and compliance training for incoming authorization agents.
- Operational Stabilization (Special Assignment): Intervened during an unexpected leadership transition to manage end-to-end pending case inventories via bi-daily Excel tracking, successfully mitigating account escalations and stabilizing backlogs.
Authorization Representative (The Brooklyn Hospital Center) at Med-Metrix (2024-08 – 2025-04)
- Revenue Protection: Secured patient revenue by accurately verifying insurance eligibility and obtaining prior authorizations via web portals and direct payer communication.
- Billing Accuracy: Ensured Coordination of Benefits (COB) and updated financial classes to ensure clean claim submission and reduce denials.
- High Performance: Consistently maintained a 120% productivity rate, exceeding daily quotas while improving the patient intake experience.
Customer Service Representative (Humana) at Sagility (2022-08 – 2024-03)
- Issue Resolution: Leveraged CRM tools to manage complex insurance policy inquiries, optimizing follow-up efficiency for benefit verification and claims adjudication.
- Data Integrity & Privacy: Upheld 100% compliance with HIPAA and PHI regulations while managing confidential patient and provider data within high-volume databases.
- Service Excellence: Streamlined high-volume call workflows, maintaining a 80%+ positive satisfaction rating during peak periods.
- Performance Recognition: Awarded "Top Agent of the Month" for exceptional service quality, achieving a cumulative satisfaction rating of 81.48% based on 54 unique positive survey contributions.
