LaQusha Zamora
Detail-oriented healthcare professional with experience in medical claims review, EMR systems, and revenue cycle processes, leveraging analytical skills and AI tools to improve accuracy and efficiency.
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About
Experienced Medical Billing and Insurance Specialist with 8+ years of expertise in claims processing, appeals, arbitration, and revenue cycle management. Skilled in analyzing complex insurance disputes, ensuring regulatory compliance, and improving payment outcomes. Proven ability to manage high-volume workloads, train staff, and collaborate with providers and payers across commercial and government healthcare programs.
Experience
Health Insurance Specialist (Arbitrator) at Provider Resources (2023-06 – 2026-03)
- Reviewed and adjudicated payment disputes under the No Surprises Act (NSA)
- Analyzed documentation and applied federal regulations for payment determinations
- Maintained accurate documentation within government systems
- Performed quality assurance reviews for compliance and accuracy
- Managed high-volume caseloads with strict deadlines
Medical Billing & Collections Team Leader at Accordias Healthcare (2017-10 – 2023-06)
- Led billing and collections operations ensuring timely claim processing
- Managed appeals, denials, and resubmissions to maximize reimbursement
- Verified insurance coverage and maintained billing records
- Tracked claims from submission through resolution
- Trained and mentored new hires
- Worked with Tricare, TriWest, BCBS, Medicaid, VA, and commercial plans
Medical Office Clerk / Billing Clerk at All Pro (2016-01 – 2017-12)
- Performed coding, charge entry, claims submission, and payment posting
- Reviewed patient records for coding accuracy
- Processed payroll data and maintained confidential records
- Followed up on outstanding accounts to reduce unpaid balances
- Conducted audits to ensure compliance with regulations
Education
Associate of Science – Draughons Junior College
