Abigayl Dubon
Torrance
Summary
Healthcare billing and customer support professional with 6+ years of combined payer and provider experience at Aetna and Optum Health. Proven track record resolving high-complexity claims, guiding providers and billing teams through revenue cycle workflows within SaaS-based healthcare platforms, and ensuring strict HIPAA compliance in remote, high-volume call center environments. Skilled at root cause analysis, denial management, and translating technical billing issues into clear resolutions — consistently meeting or exceeding CSAT and resolution time benchmarks.
Overview
6
6
years of professional experience
Work History
Health Concierge – Billing & Claims Support
CVS Health / Aetna
04.2022 - Current
- Resolved 80+ complex inbound billing and claims inquiries daily across multiple support channels, maintaining a 95%+ first-call resolution rate and consistently exceeding CSAT benchmarks.
- Performed root cause analysis on denied claims and recurring billing errors, identifying payer trends and recommending corrective actions that reduced repeat contacts by an estimated 20%.
- Educated members on insurance benefits, plan structures, CPT/ICD-10 coding, and coverage policies — improving member understanding and reducing escalations to senior support tiers.
- Guided members through the full claims appeals process — from EOB review to resubmission — ensuring accurate documentation and timely resolution in compliance with payer policies.
- Maintained detailed, HIPAA-compliant records of all member interactions, resolutions, and follow-up actions within Salesforce CRM, achieving 100% documentation accuracy per QA audits.
- Collaborated with clinical, billing, and plan administration teams to escalate and resolve complex coverage disputes, reducing average resolution time through coordinated cross-functional workflows.
- Identified and documented recurring system limitations and payer policy gaps, escalating findings to internal operations teams to support process and platform improvements.
- Upheld strict adherence to HIPAA regulations and healthcare data security protocols across all customer interactions and PHI handling.
Provider Billing Support Specialist
Optum Health
05.2020 - 03.2022
- Managed end-to-end revenue cycle support for provider offices and billing teams — covering claims submission, payment posting, and denial resolution — reducing outstanding claim backlogs by streamlining intake workflows.
- Investigated and resolved claim denials by analyzing EOBs and applying CPT/ICD-10/HCPCS coding knowledge to identify root causes, resulting in measurable improvement in clean claim submission rates.
- Guided providers through insurance eligibility verification, prior authorization workflows, and CMS form requirements (CMS-1500, UB-04), decreasing submission errors and accelerating reimbursement timelines.
- Troubleshot EHR/EMR and practice management software issues for provider billing teams across a portfolio of 50+ provider accounts, resolving platform errors and improving workflow efficiency.
- Coordinated directly with payers and clearinghouses to resolve EDI transmission errors, claim rejections, and eligibility discrepancies, cutting average payer response turnaround time.
- Documented recurring payer issues, system bugs, and billing trends, escalating findings to product and operations teams to drive platform improvements that reduced ticket volume.
- Delivered best-practice guidance on revenue cycle management, collections strategy, and denial management within SaaS-based healthcare platforms — improving provider self-sufficiency and reducing inbound support contacts.
Education
High School Diploma -
Skills
- CPT, ICD-10, HCPCS Coding
- Denial Management Appeals
- Revenue Cycle Management
- HIPAA Compliance & PHI Security
- EDI Enrollment Payer Communications
- CRM Platforms
- Root Cause Analysis & Trend Identification
- EHR/EMR & Practice Management Software
Technical Proficiencies
CPT, ICD-10, HCPCS, EOB Analysis, EDI Enrollment, CMS-1500 & UB-04 Forms, Payer Policy Interpretation, Salesforce CRM, Zendesk, EHR/EMR Systems, ITSM Platforms, Microsoft Office Suite, HIPAA, PHI Handling Best Practices, Healthcare Data Security
Timeline
Health Concierge – Billing & Claims Support
CVS Health / Aetna
04.2022 - Current
Provider Billing Support Specialist
Optum Health
05.2020 - 03.2022