Sofia Mei Zapanta

I have experience with claims follow-up and familiarity with various Explanation of Benefits (EOBs) have shaped me into a reliable and dedicated professional. Having managed accounts from states like California, Nevada, Alaska, and Washington, I am confident that I can navigate challenges effectively for recognized clients. I believe my previous experiences have equipped me well for this opportunity with your organization. My expertise in providing outstanding customer service further qualifies me for this role. Successful record in handling the full cycle of medical claims to facilitate prompt and accurate payment. I spot, scan, classify, and rectify the root cause of claim denials, front-end data integrity and back-end problem-solving. My duties are the modification of UB04 and CMS1500 forms while processing error correction, close review of EOB/835 remittances to identify and correct payment mistakes, and tracking Accounts Receivable (A/R) trends in a bid to proactively avoid denials. I am especially good at filing reconsideration requests and appeals and also track diligently to enable efficient claim processing.

Extremely competent in administrative tasks required for proper billing and payer compliance. I regularly update and validate patient and payer demographics and check patients' Coordination of Benefits (COB) to establish correct primary/secondary payer liability. My experience further entails examining providers' contracts to guarantee claims being submitted within negotiated terms, a vital element of ensuring successful credentialing and contracting status. I also use clinical records like laboratory results and consent forms to ascertain the merit of claims.