Independent Compliance & Integrity Analyst at Independent Consultancy (2026-04 – Present)
- Spearheaded deep-dive data audits into multi-billion-dollar corporate infrastructures to flag hidden processing gaps, illegal billing practices, and regulatory failures.
- Reconciled hour-by-hour transaction timelines and automated backend system logs to uncover and document precise corporate compliance violations.
- Successfully forced executive escalations, the manual purging of corrupt database tokens, and the direct removal of junk billing fees.
- Built airtight, chronological evidence summaries detailing system loop glitches and procedural errors to back up formal federal and state agency filings.
Account Receivable Specialist at Arizona Center for Hand to Shoulder Surgery - Contract Agency (2025-10 – 2026-03)
- Monitored and managed patient and insurance account balances to ensure timely collection of outstanding payments
- Reviewed and reconciled accounts receivable, identifying discrepancies and resolving billing issues in compliance with payor dispute guidelines
- Verified insurance coverage, eligibility, and pre-authorization requirements for medical services rendered
- Prioritized follow-up based on insurance and patient accounts receivable aging reports
Claims Research Analyst at Cranial Technologies (2023-02 – 2025-07)
- Conducted reviews of patient health records, including complex progress notes and clinical summaries, to cross-reference medical necessity data and invalidate inaccurate payer denials.
- Managed the full life cycle of a claim in a hybrid environment, strategically communicated with insurance carriers and patients to resolve multi-tiered reimbursement blocks.
- Audited high-volume commercial and government reimbursement pipelines against contract metrics to isolate, dispute, and systematically recover underpaid claims which includes manual appeals.
- Engineered data-driven workflow improvements and daily electronic funds transfer (EFT) reporting models to accelerate pipeline velocity and eliminate compliance gaps.
Customer Relations Representative at Centene Envolve Dental (2021-12 – 2023-01)
- Assisted members by answering benefit plan questions and troubleshooting unpaid claims for self-reimbursement and provider billing statements
- Managed inbound calls from members and providers, escalating complex cases for timely resolution of referrals, authorizations, single case agreements, and claims reviews
- Delivered clear communication to enhance member and provider satisfaction with insurance processes including dental terminology
Sr. Accounts Receivable at Change Healthcare (2018-05 – 2021-03)
- Examined denied or short-paid claim portfolios to uncover root-cause patterns among specific commercial or government payers, executing account reconciliations to reverse financial leaks.
- Spearheaded high-level communications with University of California liaisons, physician groups, and clinical teams to resolve documentation gaps and secure accurate, accelerated coding corrections.
- Acted as the department Subject-Matter Expert (SME) on CMS regulations and payer guidelines, mentoring junior AR associates and auditing team outputs to ensure maximum compliance.
- Managed high-velocity electronic and paper clearinghouse transmission pipelines, leveraging strict contract logic to aggressively appeal and overturn complex payer rejections.
Provider Services CSR II at Centene (2016-02 – 2018-05)
- Provided assistance to physician offices regarding claims, eligibility, covered benefits, appeals, and authorization status, documenting all activities
- Researched and identified processing inquiries in claim payments, adjustments, and denials, routing to appropriate teams when necessary
- Identified trends in provider inquiries leading to policy or process improvements supporting service levels and quality standards
- Collaborated cross-functionally on special projects and process improvements
