Appeals Coordinator Resume
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.
Skills : Project Management, Provider Network, Healthcare, Technology Consulting.
Description :
- 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.
Experience
2-5 Years
Level
Junior
Education
Bachelor Of Arts
