12+ Yrs Healthcare Back Office Specialist | Claims, QA & Compliance

Overview

Looking for any work (8 hours/day)

at $5.81/hour ($1,120.00/month)

Bachelor's degree

Last Active

July 8th, 2026 (today)

Member Since

April 4th, 2026

Profile Description

I help healthcare organizations, insurance providers, and medical support teams improve claims accuracy, streamline workflows, and maintain high-quality standards through reliable back-office support and process expertise.

With over 12 years of experience in US healthcare insurance, I specialize in claims processing, appeals and correspondence, quality assurance, provider data management, and SOP-driven operations. I am highly experienced in handling high-volume workloads while maintaining strict compliance, accuracy, and turnaround times.

What I Can Help You With

Health Insurance Claims Processing

• End-to-end claims review, validation, adjudication, and resolution
• Claims investigation and discrepancy handling
• Accurate documentation and compliance with client SOPs

Appeals & Correspondence Management

• Review of denied or disputed claims and supporting documentation
• Evaluation of appeal cases based on policy guidelines and claims review findings
• Review and quality checking of appeal response letters sent to providers
• Ensuring accurate, compliant, and timely correspondence related to claims denial decisions

Quality Assurance (QA) & Auditing

• Claims and correspondence auditing
• Error detection and root-cause analysis
• Quality metrics monitoring and compliance checking
• Process improvement recommendations

Provider Data Management

• Provider enrollment and profile maintenance
• Data accuracy and system integrity management

Administrative & Operations Support

• SOP creation and documentation
• Invoicing and payment tracking
• Data annotation and data management
• Workflow coordination and process organization

• Systems & Tools I Use
Facets
Citrix
Knowledge Xchange
Medical Records Systems
CAQH
CCMS
RingMaster
Intake Q&A
Microsoft Office Applications
Google Workspace
ClickUp
Notion
Slack
WhatsApp
Webex

• Others
ServiceM8
Tradify
GeoOp
Monday CRM

Why Clients Work With Me

• Strong attention to detail
• HIPAA-compliant work practices
• Fast learner with minimal supervision required
• Reliable turnaround and deadline management
• Excellent accuracy in high-volume environments
• Strong analytical and problem-solving skills
• Experienced in client-specific SOP compliance

I am committed to delivering accurate, efficient, and dependable support that helps businesses maintain operational excellence and streamline workflows.

Let’s work together to streamline your processes and achieve high-quality results.