Appeals Coordinator

Wellcare Brandon,Florida

company and departmental policies and procedures . Experience Appeals Coordinator 09/2013 to Current Wellcare Tampa , FL Process Provider appeals regarding claims for hospitals , physicians , Therapist...medical service . Review medical claims , medical records and authorizations to ensure that the appeals is handled accurately and professionally . Integrated Services Specialist 09/2010 to 09/2013 Coventry

Appeals Coordinator

Well Care Health Plans Inc Tampa,Florida

guidelines . EXPERIENCE 09/2017 to Current Appeals Coordinator Well Care Health Plans Inc － Tampa , FL Log , track , and process health service appeals and grievances . Serves as a liaison in cor...associated with the processing and handling of appeals to comply with regulatory standards and timeframes while maintaining an accurate , complete appeals record in the electronic database . Perform ...within the department . Notifies Supervisor or other appropriate parties of identified patterns of appeals , claim errors , configuration issues , or other system problems identified during appeal processing

Grievance and Appeals Coordinator

Cenpatico Kyle,Texas

Grievance and Appeals Coordinator , 10/2015 to Current Cenpatico – Austin , TX Gather , analyze and report verbal and written member and provider complaints , grievances and appeals Prepare response...response letters for member and provider complaints , grievances and appeals Maintain files on individual appeals and grievances Develop and maintain positive customer relations with internal and external customers...years in managed care . Strong background in quality assurance , claims analysis , grievances and appeals . Skilled at communicating , organizing and solving problems to raise the rankings of health care

Revenue Recovery Services

Spring,Texas

technology to resolve overpayment and/or payment errors , All other duties as assigned , Appeals Coordinator 03/2018 to 11/2018 Dr , Robert J Cornell , M , D , , Houston , TX Medical...ion Route all insurance denials to insurance accounts receivable team for re , submission and appeals Worked with medical teams , patients and families to implement effective treatment plans Problem...payments to accounts and maintained records Review and appealing denied and unpaid claims Process all appeals and / or payer dispute/ complaints for escalated claims processing once the claim has been accepted

Surgery Coordinator

Veinsolutions & Demeter Surgical Dayton,Ohio

patients to verify information , determine purpose of visit and record medical history . Appeals Coordinator , 03/1995 to 12/2007 Anthem Blue Cross/Blue Shield – Dayton , OH Tracked all pending aut...Professional Summary Compassionate Surgery Coordinator with [Number] years helping others through personal excellence . Employs strong administrative , organizational and interpersonal skills to achieve...collections Customer service Communications MS Office Relationship development Work History Surgery Coordinator , 06/2016 to 06/2020 Veinsolutions & Demeter Surgical – Dayton , OH Communicated with patients

Grievance and Appeal Manager

TENET HEALTH Peoria,Arizona

Provided performance feedback to management staff . Participated in special projects as needed . Appeals Coordinator 07/2008 to 10/2014 ADVANTAGE HEALTHCARE MANAGEMENT Phoenix , Arizona Arbitrated provider claim...the intake , triaging , coordination , and documentation of all grievances , complaints and appeals within the department to promote consistency and accuracy . Maintains quality control processes to...Ensures all regulatory requirements are met regarding the resolution of member grievances , member appeals and provider claim disputes for the Plan's Medicare , Medicaid and Healthcare Exchange lines of

Psychiatric Intake Triage Coordinator

CHA-Everett Hospital Newton Center,Massachusetts

sound working relationship with internal and external customers . Clinical Support Specialist Appeals Coordinator Mar 1998 - May 2003 Magellan Behavioral Health Burlington , MA Handle high volume of incoming...confidential and pertinent clinical information into database 8 as an Appeal Coordinator , I managed all incoming mails related to Appeals and Grievances . 9 Responsible for entering and updating all Appeal ...Health Insurance Industry regarding Prior - Authorization and Claims reimbursement . Familiar with Appeals , Doc to Doc , Insurance Verification . Certifications 1 Certified C . P . R . /C . P . I . 2

Utilization Management Specialist

St Joseph Heritage Healthcare Anaheim,California

meet establishing productivity , scheduling adherence , and quality assurance standards . Appeals Coordinator , 12/2012 to 01/2015 United Health Group – Cypress , CA Ensured all member complaints were...meet establishing productivity , scheduling adherence , and quality assurance standards . Appeals Coordinator , 12/2012 to 01/2015 United Health Group – Cypress , CA Ensured all member complaints were...Scan and Healthnet Highlights Healthcare Tools : Allscripts/Touchworks , Providers Portals , Appeals Portals , IDX , Cal Optima Web , CHOC Health Alliance Web , Medical/Medicare Portals . Microsoft

Medical Record Retrieval Specialist

Outcomes Health Soultions Houston,Texas

inquires from matrix partners and ensure resolution within required time frame . Complaint/ Appeals Coordinator Jan 2001 to Jan 2002 Blue Cross Blue Shield － Houston , Texas This position acquires and retains... Texas Respond to provider inquires concerns , complaints , appeals , and grievances . Handle appeal status calls and assist appeals coordination with communications and documentation . Processes internal

Case Management Coordinator

Aetna, Inc Surprise,Arizona

network providers , payor sources , and community stakeholders .   Grievance and Appeals Coordinator 09/2007 to 12/2007 Magellan Health Services , Inc – Phoenix , AZ Responsible for timely...Health Services standards and regulations . Completed screening and assignment of grievances , appeals and provider claims disputes in compliance with all State and Federal laws and regulations along...Specialist 04/2007 to 09/2007 Value Options , Inc – Phoenix , AZ Completed screening process for appeals , grievances and provider claim disputes for Regional Behavioral Health Authority recipients