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Appeals Manager Resume Example

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APPEALS MANAGER
Career Overview
I desire to use my leadership, educational skills and accomplishments to help an organization achieve business goals and objectives.
Professional Experience
January 2014 to November 2014
Zoll Life VestPittsburgh, PaAppeals Manager

  • Manage Durable Medical Equipment, wearable cardiac defibrillator called the Life Vest.
  • Acted as a liaison between patient and insurance companies for reconsiderations and appeals for payment for the life vest.
  • Manage 20 Appeal Coordinators, all exempt staff.
  • Full-time) Sharon Kim Mgr.
  • 412-968-3333 HR 40 plus hrs.
January 2005 to April 2013
Formally Highmark Medicare ServicesPittsburgh, PAClaims Operations Supervisor
  • Managed two separate departments, 30 direct reports from 2010-2013.
  • I managed Claims Processors for Medicare Part A.
  • insurance.
  • I was responsible to recruit, train, motivate and manage all staff to meet standards timely and efficiently.
  • I developed processes, procedures and coordinated job activities to support program requirements of completing claims within 30 days.
  • I tested benefit updates within the system and created procedures for the new CMS benefit updates.
  • I also motivated employees to perform well within production standards.
  • I managed Qualified Independent Contractor (QIC) clerical employees.
  • The assignments success was measured by a 5-day program requirement for each case received met quarterly.
  • Sue Williams-Mgr.
  • 501 Grant St Pittsburgh 901-791-8676 BCBS of Florida (Full-time) 40 plus hrs.
January 2000 to December 2004
Highmark IncPittsburgh, PAClaims Operations Supervisor
  • I managed all lines of business within claims processing division.
  • Worked with Indemnity, Major Medical, HMO, Medigap and Point Of Services product lines.
  • I developed and trained staff to complete assignments timely and efficiently.
  • I Monitored the claims outsource companies, Walsh Health Care and Regence Blue Cross Blue Shield inventory.
  • I administered monthly financial disbursements and quarterly reports.
  • In addition, I also supervised 12 Imaging Staff due to operational realignment and was responsible for claims being sorted and Imaged and was accountable for monitoring outsourced claim completion.
  • Lead exempt and non-exempt staff.
  • Mary Ann Jenkins Mgr.
  • 120 Fifth Ave Pl.
  • Pittsburgh Pa 412-544-7000.
  • Full-time) 40 plus hrs.
January 1998 to January 2000
Highmark Blue Cross Blue ShieldPittsburgh, PAOperations Claims Trainer
  • As an Operations Claims Trainer I trained Indemnity Blue Cross Blue Shield, Point Of Service,.
  • HMO, Health Management Organization, benefits for claims processing.
  • I developed training methods and tracked and monitored class success rates as well as provided processing training to help support company demands for skilled processors and customer service representatives.
  • I trained over 15 new hires and existing staff.
  • Introduced training programs that enhanced employee performance and helped build a motivated workforce.
  • Managed and successfully trained staff that were promoted to higher level positions within the organization.
  • Darlene Thomas Mgr, 120 Fifth Ave Pl Pittsburgh Pa 412-544-7000.
  • Full time 40 hrs.
Education
5/99
CARLOW UNIVERSITY
PITTSBURGH, PACOMMUNICATIONS
BACOMMUNICATIONS
12/11
LIBERTY UNIVERSITY

Interests
FLOCK INC. CEO - WOMEN EMPOWEREMENT Mentoring Group 2011- Present. The Youth Project- Volunteer Alternative Education project at Penn Hills High School Self Esteem facilitator, October 2012 - May 2013. Women Empowered for Entrepreneurial Excellence Small Business Jump Start Program graduate 2013. First Antioch Baptist Church of Greensburg -2005-Present Pastor's Wife, Sunday school teacher, Women's Ministry Chair Produced several women's conferences for health, wellness and spiritual growth. Produced "FLAVA" Faith Lives and Victory Abounds" women's conference 2013, "Faithbook Youth Conference" 2012 "Armor of God" youth conference 2010 and the "Power of Praise" 2009, "God's Girls and Goals" 2009, Faith and Business Community Job Fair, Greensburg Pa, November 2013
Additional Information
  • MA CHRISTIAN LEADERSHIP Training/Volunteer Work FLOCK INC. CEO - WOMEN EMPOWEREMENT Mentoring Group 2011- Present. The Youth Project- Volunteer Alternative Education project at Penn Hills High School Self Esteem facilitator, October 2012 - May 2013. Women Empowered for Entrepreneurial Excellence Small Business Jump Start Program graduate 2013. First Antioch Baptist Church of Greensburg -2005-Present Pastor's Wife, Sunday school teacher, Women's Ministry Chair Produced several women's conferences for health, wellness and spiritual growth. Produced "FLAVA" Faith Lives and Victory Abounds" women's conference 2013, "Faithbook Youth Conference" 2012 "Armor of God" youth conference 2010 and the "Power of Praise" 2009, "God's Girls and Goals" 2009, Faith and Business Community Job Fair, Greensburg Pa, November 2013
Skills
benefits, clerical, CMS, Cost-Reduction, Customer Service, documentation, financial, financial reports, Financial report, HR, Imaging, insurance, inventory, Teambuilding, Operations Management, Organizational Skills, Pl, processes, Processors, Project Management, requirement, Supervision, Trainer I, training programs
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Resume Overview

Companies Worked For:

  • Zoll Life Vest
  • Formally Highmark Medicare Services
  • Highmark Inc
  • Highmark Blue Cross Blue Shield

School Attended

  • CARLOW UNIVERSITY
  • LIBERTY UNIVERSITY

Job Titles Held:

  • Appeals Manager
  • Claims Operations Supervisor
  • Operations Claims Trainer

Degrees

  • COMMUNICATIONS BA

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