Appeals Coordinator Resume Example Wellcare

APPEALS COORDINATOR

Summary

Call Center Representative versed in customer support in high call volume environments. Superior computer skills and telephone etiquette. While offering a record of successful job performance, proven problem solving ability and experience developing and implementing innovative solutions.

Skills

15 years +customer service and enrollment, accounts receivable or claims processing experience.
Able to effectively handle multiple tasks.
Demonstrates effective keyboard skills; ability to navigate within a computer/systems-dependent environment without assistance; experience in a windows-based computer environment.
Excellent verbal and written communication skills.
Displays a positive, confident attitude; highly self-motivated and accountable.
Able to absorb and apply new and changing information.
Able to quickly think.
Responds positively to goal-setting and performance measurement.
Able to manage personal stress; can remain calm and controlled in stressful, unexpected situations; can easily adapt and effectively respond to shifts in priorities and unexpected events.
Able to provide constructive feedback and serve as a mentor.
Strong analytical and problem solving skills.
Independent decision-making skills.
Strong listening and interpersonal skills; skilled at developing and maintaining effective working relationships.
Excellent organizational and time management skills.
Able to maintain regular and consistent attendance in accordance with company and departmental policies and procedures.

Experience

Appeals Coordinator09/2013 to CurrentWellcareTampa, FLProcess Provider appeals regarding claims for hospitals, physicians, Therapist and Mental health providers of service. Working closely with claims department and Medical Nurses regarding denied medical service. Review medical claims , medical records and authorizations to ensure that the appeals is handled accurately and professionally.

Integrated Services Specialist09/2010 to 09/2013Coventry Health Care IncTampa, FL

Interfaces with customers via telephone, fax, and/or electronic mail to respond to inquires and resolve concerns, including those of a difficult and challenging nature.
Processes enrollment forms, account receivable inquiries, paper claims and/or electronic work queues accurately and efficiently including complex HCFA 1500 and UB92 forms.
Interprets and processes difficult adjustments in accordance with company policies and procedures.
Reviews basic pending claims to determine the appropriateness of the claim status and takes necessary action based on status.
Investigates, analyzes and resolves outstanding issues to achieve customer satisfaction; uses a systematic approach in solving problems for equipment needs, claims or billing questions/issues through analysis and evaluation of information and alternate solutions.
Anticipates and quickly identifies customer needs.
Acts independently and manages own activities with minimal supervision and direction to meet customer needs using sound decision making.
Uses good judgment and logic in evaluating and resolving difficult enrollment, accounts receivable or claims issues.
Maintains phone and claims quality, and performance levels while working on customer related and other special projects.
Serves as a training resource and mentor to others, particularly new hires.
Shares best practices.
Continuously seeks avenues for developing professional expertise and actively pursues new learning opportunities, which support the company's goals and objectives.

CareCentrix02/2009 to 08/2010Provider ServicesTampa, FL

Eligibility and Benefit verification for Medical procedures and DME.
Via phone/fax or Florida Date base, Internet and Intranet for private carriers.
Handled Medicaid, Medicare and private carriers.
I was an SME (subject matter expert) which landed me in Overland Park, Kansas for a 3 months to train new hires for the opening of a new center.
I was selected after 8 months of employment, which was an honor for my hard work and dedication.

Customer Service Rep08/2004 to 02/2009CCS MedicalClearwater, FL

Handled reorder for diabetic supplies, contacted patients to verify their request and make any corrections necessary.
Contact patients whom order has not been received to assure they have enough supplies on hand.
Contact the Provider office for expired paper work pertaining to the type of insulin and supplies prescribe to the patient.
Data updates for the patients and providers as well as handled inbound calls.

Education and Training

Diploma: Medical Office1993Concorde Career InstituteTampa, FL, United StatesMedical Office Medical Transcription, Healthcare billing and Reimbursement, Medical Records, Medical Terminology, ICD 9 coding, Medical Office Procedures, Accounting, Anatomy and Introduction to Health Information Management.

Skills

Accounting, accounts receivable, Anatomy, basic billing, interpersonal skills, customer satisfaction, customer service, decision-making, electronic mail, fax, forms, goal-setting, 10 key, Medical Terminology, Medical Transcription, mentor, Office, windows systems, organizational, problem solving skills, Processes, coding, quality, self-motivated, strong time management skills, great organizational skills , type, written communication skills.

Activities and Honors

Team Player & Peep to Peer Regconition , Subject matter expert . Volunteer with the WAVE Association to help non profit organizations such as Metropolitan Ministries and Habitat for Humanity and Horses for Kids.

Resume Overview

Companies Worked For:

Wellcare
Coventry Health Care Inc
Provider Services
CCS Medical

School Attended

Concorde Career Institute

Job Titles Held:

Appeals Coordinator
Integrated Services Specialist
CareCentrix
Customer Service Rep

Degrees

Diploma : Medical Office 1993

Appeals Coordinator Resume Example

Resume Score: 90%

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