The role of an Appeals Coordinator is to investigate on the complaints received from the Patient’s end and solve it satisfactorily. Summary of duties listed on the Appeals Coordinator Resume include – responding to complaints immediately, evaluating eligibility criteria of suitable cases, conducting investigation for detecting negligence on part of the hospital team, advising legal actions, taking suitable action against offending staff, listening to the grievances, preparing information report, detecting the truth of the lodged complaint, and arranging for compensation if the patient’s complaint is true.
To become as Appeals Coordinator, possessing these skills would prove to be resourceful – a comprehensive knowledge and awareness of healthcare service and medical terminologies, familiarity with CPT/ HCPC and ICD9 coding; ethical behavior, the discrepancy to maintain confidentiality and the ability to work as per medical rules guidelines. A Bachelor’s degree in Business or Hospital Management is commonly seen on most of the resumes.
Summary : An innovative, flexible, take charge individual with experience in organizing, decision making, team building and utilizing technology for improving business practices.
Skills : Management, Patient Accounting.
Description :
Directly supervises the Denial Management follow-up unit.
Tracks monthly collections and follow-up of all appeals filed by nursing/physician assistant staff as well as all technical appeals.
Development and implementation of the complete inpatient follow up process.
Responsible for the training of all new follow up staff to ensure consistency and accuracy is maintained throughout the department.
Strategizes and develops follow up activities to maximize recoveries.
Creates standardize reports that track overturn rates, aging and collection progress throughout the month.
Consistently identifies data base issues and provides process improvement recommendations to the IS Department which are implemented to meet the ongoing needs of our clients.
Established- outpatient revenue cycle recovery process, which has yielded an overturn rate of approximately 50%.
Experience
10+ Years
Level
Senior
Education
Associates Of Science
Sr. Appeals Coordinator Resume
Headline : Seeking a position in an office setting assisting with clerical and office support functions. Seeking a position in the medical field.
Skills : Multi-line phones, Filing, and Call center experience, Cash handling, 10 key, Typing skills.
Description :
Receives documents, investigates, refers and coordinates grievances and appeals.
Maintains database for completing appeal reports required by agencies and the organization.
Research and analyze Medicare claims and related material including customer history.
Compose formal letters of redeterminations and other issues.
Appropriately use the system for tracking/trending purposes.
Keep abreast of all changes/updates regarding Medicare policy and departmental guidelines.
Reviewed and reprocessed, when necessary, Medicare B claims to utilize a thorough knowledge of ICD9, CPT, and HCPCS codes to ensure a 99% accuracy billing rate.
Provided prompt customer service to members, providers, billing departments, and other insurance companies regarding claims.
Experience
5-7 Years
Level
Executive
Education
Nursing
Jr. Appeals Coordinator Resume
Summary : Accomplished professional with excellent inter-personal, communication, and leadership abilities seeking long term employment with a stable organization.
Upholding and following through with all CMS regulations.
Processing all pre and post-service appeals for Medicare and retirement members.
Determining member's eligibility for appeal.
Close communication with Doctors and Nurses to assist in medical/DME appeals.
Coordinate with hospitals, institutions, and medical facilities to obtain medical records, claims, denials, explanations of benefits, explanation of payments, and all other documents needed pertaining to cases.
Customer Service Generating Maximus packets with the determination of cases, as well as mailing them out.
Adjudicating and key in claims for processing.
Experience
7-10 Years
Level
Management
Education
Diploma In Medical
Lead Appeals Coordinator Resume
Summary : Over fifteen years in the Medical Insurance Industry: Customer Service Specialist, Research Assistant, Medical Claims Examiner and currently Appeals Coordinator.
Skills : Effectively present information and Respond to questions from families, members, and providers.
Description :
Managed all aspects of the appealing and contesting parking citations.
Defused potentially volatile situations and dealt with agitated customers in person, over the phone, and through e-mail correspondence.
Reduced the number of citations by evaluating signs and pavement markings and advised suggested changes to clarify parking policies.
Reduced the number of citations by evaluating patterns of citations issued.
Entered daily as many as 50 appeals, both written and e-mail, into the Flex parking program.
Researched, evaluated, and adjudicated as many as 35 appeals daily.
Responded to hundreds of e-mails on a weekly basis from customers, coworkers, and university associates.
Advised senior management on policy changes and improvements.
Experience
7-10 Years
Level
Management
Education
Bachelor Of Arts
Appeals Coordinator III Resume
Objective : Over 10 years of experience in customer care, service, and clientele case management. Initiated revitalization of struggling Women, Infant & Children office by increasing casework load by 30% to 50%.
Skills : Healthcare, Microsoft.
Description :
Follow-up and coordinate all clinical denials.
Maintain a comprehensive denial database to track and trend denials information and identify opportunities for improvement.
Collaborate with Cymetrix to communicate denial/appeal status and determine payment.
Develop denial prevention strategies based on trended information.
Work with the utilization review team to ensure all Illinois Medicaid Certification are completed in a timely manner, in order to prevent a denial.
Track all Illinois Medicaid ICD 10 certification codes to ensure correct coding for payment.
Acting as a liaison for multiple external organizations.
Experience
2-5 Years
Level
Junior
Education
Healthcare Administration
Appeals Coordinator II Resume
Summary : Dedicated professional seeking a position to utilize skills gained through ten years of management experience. Versatility with agency funding, budgets, contract sales, accounts receivable, collections, employee training and customer service will benefit a professional team.
Skills : MS Office, MS Excel.
Description :
Review, research and investigate inquiries and appeals, communicate resolution to the member and provider in accordance with federal regulations.
Utilize sound judgment to assess each complaint and identify pertinent issues.
Complete responses within the appropriate timeframes while meeting the established quality standard.
Assist other team members with routing and handling of appeals.
Assist supervisor with administrative duties to include acting team leader in supervisor's absence.
Provide resolution and prepare correspondence for provider and member issues.
Provide assistance to the billing department to obtain inpatient authorization numbers.
Experience
10+ Years
Level
Senior
Education
Diploma In General Education
Appeals Coordinator Resume
Summary : To provide excellent work ethics, through knowledge and experience; along with excellent customer service skills and offer a deep understanding of confidentiality.
Skills : MS Office, MS Excel.
Description :
Verify participant eligibility; plan documents and rules for preparation of appeal.
Contact physicians, participants and other insurance companies via phone, fax or email to obtain pertinent information for preparation or resolution of appeal.
Work with physicians to negotiate discounts and write-offs.
Maintain clear and concise information on all files.
Compose appeal and prepare file to be sent to Trustees.
Prepare approval, denial and resolution letters for participant and physicians.
Keep accurate account of appeals received daily.
Update Customer Service personnel on activity of appeal.
Experience
10+ Years
Level
Senior
Education
Certification
Appeals Coordinator I Resume
Summary : Highly motivated individual with excellent written and verbal communication skills who drives for results and is committed to pursuing a long-term career in healthcare compliance.
Skills : Symantec DLP, ProofPoint.
Description :
Determine course of action in relation to all incoming correspondence.
Initiate case file process for each grievance.
Research and assess complaints and/or grievances ensuring appropriate regulatory requirements, as well as policies and procedures are in compliance.
Responsible for ensuring all grievance decisions include the appropriate content.
Accurately type all correspondence (decision letters) within required timeframes.
Evaluate the appeal process and takes appropriate action as required.
Maintain various databases for reporting purposes.
Experience
7-10 Years
Level
Management
Education
B.A. In Performance
Appeals Coordinator/Executive Resume
Summary : Follow with Insurance carriers via telephone & written appeals based off A/R reports Credit & Collections: contacting customers either by phone or correspondence in relation to the outstanding balance on their account.
Skills : Sales, Retail, And Customer Service Experience.
Description :
Reviewed, organized, and updated appeal, health, and financial records.
Acted as a liaison between clients and Marketplace to address unresolved appeals.
Assisted appellants obtain health insurance through Marketplace.
Coordinated collection of information and presentation.
Entered details of phone conversations into computerized database and prepared documentation for further rectification.
Researched member information in response to difficult inquiries.
Scheduled and coordinated call-back appointments and follow-up calls.
Experience
7-10 Years
Level
Management
Education
BS In Psychology
Appeals Coordinator/Analyst Resume
Headline : To find an exciting new career in the Raleigh area using superior research and customer service skills.
Skills : Power Point, MS Excel.
Description :
Triaged mail and determined which category work fell into.
Maintained detailed records of inventory on cases.
Researched appeal cases for presentation to the committee for review.
Ran point on multi-person, multi-case committee meetings where appeals were voted on.
Wrote acknowledgment, uphold and denial letters regarding appeal cases.
Reviewed and responded to the Department of Insurance inquires.
Handled incoming calls and made outreach when necessary.
Experience
5-7 Years
Level
Executive
Education
Bachelor Of Arts
Appeals Coordinator/Representative Resume
Objective : Client oriented Licensed Practical Nurse with experience in several medical fields. Strong commitment to professional excellence and team motivation. Dedicated and professional in both appearance and attitude.
Skills : Excel, Power Point.
Description :
Case set up and Appeals coordinator: reviewing, researching, investigating, and triaging all types of appeals and grievances.
Communicates with appropriate parties regarding appeals and grievance issues.
Ensure complaint has been categorized correctly.
Determine and confirm member eligibility and benefits.
Obtain additional documentation required for case review.
Place relevant documents into image repository.
Initiate outbound contact to members or providers.
Experience
2-5 Years
Level
Junior
Education
Diploma
Appeals Coordinator Resume
Objective : To utilize extensive knowledge of the health insurance field to assist patients and continue gaining experience to further grow career.
Skills : Salesforce, Epic, Microsoft Office.
Description :
Triaged mail and determined which category work fell into.
Maintained detailed records of inventory on cases.
Researched appeal cases for presentation to committee for review.
Ran point on multi-person, multi-case committee where appeal cases were presented and voted on.
Wrote acknowledgement, uphold and denial letters regarding appeal cases.
Reviewed and responded to Department of Insurance inquires.
Handled incoming calls and made outreach when necessary.
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