Ehab Abdalrahman

Claims Processing & Adjudication

Reviewed and validated complex medical, surgical, and specialty insurance claims according to payer contracts and regulatory requirements.

Applied coding knowledge for ICD-10-CM/PCS, CPT, HCPCS, and DRG to ensure accurate submissions and reduce coding-related denials.

Investigated and resolved discrepancies in claims and billing errors, coordinating benefits disputes to ensure accurate claim processing.

Managed high-volume claims while ensuring accuracy and meeting turnaround time targets.

Conducted medical necessity reviews to confirm eligibility and coverage, ensuring compliance prior to adjudication.

Ensured compliance with state regulations and payer-specific requirements.

▸ Perform systematic audits and quality checks on claims processed by team members, providing documented feedback.

▸ Maintain up-to-date knowledge of coding updates, payer policy changes, and regulatory revisions; disseminate to team.

Mentorship & Knowledge Transfer

▸ Serve as primary resource for junior claims specialists and new hires on complex claim types, coding guidelines, and payer rules.

▸ Deliver structured on-job training, shadowing sessions, and individual coaching to accelerate team competency development.

▸ Create and maintain reference guides, SOPs, and training materials for ongoing team use.

Performance Standards & Accountability

▸ Establish and communicate clear performance expectations, quality benchmarks, and productivity metrics for team members.

▸ Conduct regular one-on-one check-ins and provide timely, constructive, strengths-based feedback grounded in data.

▸ Address performance gaps proactively with documented improvement plans and measurable milestones.

Process Improvement & Innovation

▸ Proactively identify inefficiencies, bottlenecks, and error trends in claims workflows; lead root cause analysis (RCA) sessions.

▸ Design and implement process improvements to drive measurable results.

Cross-Functional Collaboration & Communication

▸ Act as escalation point for complex claims issues raised by clinical, billing, coding, and provider relations teams.

▸ Represent claims department in interdepartmental meetings, payer conferences, and audit reviews.

▸ Communicate claims performance metrics, trends, and improvement initiatives clearly to management through regular reporting.

• Executed daily duties with accuracy and efficiency to support patient care.
• Successfully delivered on tasks within tight deadlines.
• Acquired and applied new skills to enhance daily operations.
• Displayed respect and friendliness while assisting colleagues and patients.