Healthcare RCM Specialist | Claims Denial Management, Medical Biller | Epic, Ope

I can do an advance level of forWith 10 years of hands‑on experience in Microsoft Excel, I specialize in building automated reporting systems, data management workflows, and analytical tools that improve accuracy, efficiency, and decision‑making. My work spans healthcare, finance, operations, and business analytics—allowing me to deliver structured, compliant, and high‑impact solutions. Key Responsibilities & Achievements - Designed and automated complex Excel workflows, reducing manual processing time and eliminating repetitive tasks through formulas, Power Query, and structured templates. - Built dynamic dashboards and KPI reports using PivotTables, slicers, charts, and advanced data modeling techniques. - Developed custom templates for invoicing, financial tracking, AR monitoring, QA scoring, and operational reporting. - Created automated data pipelines using Power Query to clean, transform, and consolidate data from multiple sources (CSV, Excel, SharePoint, system exports). - Implemented validation rules and error‑checking systems to ensure data accuracy, compliance, and audit readiness. - Performed deep‑dive analysis to identify trends, anomalies, and performance gaps across large datasets. - Optimized existing Excel files for speed, structure, and usability, improving team productivity and reducing errors. - Collaborated with cross‑functional teams to translate business requirements into automated Excel solutions. Technical Expertise - Advanced Formulas: INDEX‑MATCH, XLOOKUP, SUMIFS, FILTER, LET, LAMBDA, dynamic arrays - Power Query: ETL automation, data cleaning, merging, appending, transformation logic - PivotTables & PivotCharts: KPI reporting, trend analysis, drill‑downs - Data Modeling: Relationships, structured tables, normalization - Automation: Templates, macros (basic), workflow optimization - Data Validation: Rules, conditional formatting, error prevention - Integration: Excel ↔ Power BI, SharePoint, CSV, system exports Strengths - Highly structured and process‑driven approach - Strong focus on accuracy, compliance, and data integrity - Ability to simplify complex data for non‑technical users - Skilled in building scalable, reusable, and professional Excel systems - Consistent delivery of clean, automated, and client‑ready outputs mula and excel

- Electronic Health Records (EHR) management - Updating patient charts and ensuring compliance with HIPAA standards - Medical coding and billing (ICD-10, CPT codes

Over the past 2–3 years, I have specialized in denial management and claims resolution, supporting healthcare organizations in reducing revenue leakage, improving clean-claim rates, and accelerating reimbursement cycles. My work focuses on identifying root causes of denials, implementing corrective actions, and optimizing end‑to‑end billing workflows. Key Responsibilities & Achievements - Reviewed and analyzed denied claims across payers (commercial, Medicaid, Medicare) to determine root causes such as coding errors, missing documentation, eligibility issues, and authorization gaps. - Resolved 60–80+ denials per day through timely follow‑ups, appeals, and corrected claim submissions, ensuring compliance with payer-specific guidelines. - Prepared structured appeal letters with supporting documentation, increasing overturn rates and reducing repeat denials. - Collaborated with billing, coding, and clinical teams to correct systemic issues and prevent recurring denial patterns. - Monitored aging reports and AR trends, prioritizing high‑value and time‑sensitive claims to maximize recovery. - Utilized Excel, Power Query, and reporting dashboards to track denial categories, appeal outcomes, and payer performance. - Implemented process improvements that reduced denial volume by identifying workflow gaps and recommending corrective actions. - Ensured compliance with HIPAA, payer policies, and internal quality standards throughout the claims lifecycle. Tools & Platforms - Advanced Excel (Power Query, PivotTables, automation) - Clearinghouses (Availity, Change Healthcare, Waystar, etc.) - EHR/EMR systems (Epic, Kareo, Athena, DrChrono, or similar) - Payer portals for claim status checks and appeals Core Strengths - Strong analytical approach to denial root-cause identification - Excellent written communication for appeals and payer correspondence - Process-driven mindset with focus on accuracy and compliance - Ability to manage high-volume workloads while maintaining quality

I have 2–3 years of practical exposure to medical coding concepts as part of my work in denial management, claims review, and revenue cycle operations. While I am not a certified coder, I work closely with coding teams and apply coding knowledge to ensure accurate claim submission and faster reimbursement. Key Areas of Familiarity - ICD‑10 Diagnosis Codes Understanding of common diagnosis categories, medical necessity requirements, and how diagnosis coding impacts payer approval and claim outcomes. - CPT & HCPCS Procedure Codes Familiar with procedure coding for office visits, behavioral health services, telehealth, and outpatient services, including modifiers that affect reimbursement. - Coding-Related Denial Resolution Experience identifying and correcting denials related to: - Incorrect or missing modifiers - Mismatched diagnosis and procedure codes - Bundling/unbundling issues - Non-covered or invalid codes - Medical necessity denials - Documentation Review Ability to review provider notes, encounter forms, and superbills to verify coding accuracy before resubmission or appeal. - Payer-Specific Coding Rules Knowledge of coding guidelines used by Medicare, Medicaid, and commercial payers, including NCCI edits and LCD/NCD requirements. How This Supports My Work - Improves clean claim rate by catching coding issues early - Strengthens appeal letters with accurate coding justification - Reduces repeat denials by identifying root-cause coding errors - Enhances collaboration with billing and coding teams - Ensures compliance with payer policies and documentation standards