In my previous role, I analyzed large datasets of healthcare claims using tools like SQL and Excel to identify discrepancies in payments. I cross-referenced claims against payer contracts and fee schedules to ensure accuracy. By identifying patterns of overpayments or underpayments, I helped recover significant funds for the organization. My attention to detail and understanding of coding and billing regulations ensured compliance and minimized financial risks.

I regularly attend webinars, read industry publications, and participate in professional forums to stay informed about regulatory changes. I also collaborate with compliance teams and network with peers to share insights. This proactive approach ensures I can adapt quickly to new policies, maintain compliance, and implement necessary adjustments to payment integrity processes.

In one instance, I identified a recurring underpayment issue due to misinterpretation of a payer contract. I conducted a root cause analysis, collaborated with the payer to clarify terms, and updated internal systems to prevent future errors. This resolution not only recovered lost revenue but also improved the accuracy of future claims processing.

I have extensive experience with tools like SQL for data querying, Excel for analysis, and claims management systems such as EPIC and Cerner. I also use data visualization tools like Tableau to present findings. These tools enable me to efficiently identify discrepancies, track trends, and communicate insights to stakeholders.

I implement a systematic approach by double-checking data entries, validating results against source documents, and using automated tools to flag anomalies. I also maintain detailed documentation of my processes and findings. This methodical approach minimizes errors and ensures the reliability of my analyses.