9061 N Brookview Ave
Sacramento, CA, 95833
Job Objective Seeking an Appeals Coordinator position where I can apply my experience and efficiently contribute to the company’s growth.
Appeals Coordinator, May 2004 – Present
Abrazo Advantage Health Plan, Sacramento, CA
- Concentrated on administrative appeals and provided support on clinical edit claims review to the dept Nurse Coordinator.
- Established and ensured workflow continuity with the Plan in the areas of Claims Processing, Provider Servicing and Health Services.
- Developed and researched data and records to ensure in time processing of administrative appeals in accordance with BMCHP guidelines.
- Created administrative appeals reports for management and analyzed ad hoc reports.
- Ensured the quality and organization of administrative appeal documentation.
- Ensured continuous improvement of the administrative appeals process and established related workflows as needed in response to Plan policy and procedure and claims processing changes.
- Recognized and communicated trends.
- Collaborated with other departments to create and implement improvement plans.
Appeals Coordinator, March 2002 – April 2004
Health Net, Sacramento, CA
- Conducted appeal and reviews to ensure federal regulations are followed.
- Prepared, drafted, executed, followed-up and defended appeals, as appropriate, pursuant to governmental and commercial pay or policies.
- Maintained records, answered correspondence, prepared and disseminated reports.
- Tracked laws and regulations that affected the organization’s policies and stayed current on changes and trends.
- nalyzed medical and clinical documents for government, regulatory and compliance.
- Prepared and presented compliance reports to management.
- Conducted focused and random compliant audits.
- Assisted with internal compliance education.
Summary of Qualifications:
- Registered Nurse with extensive experience coding in a clinic and hospital setting
- Familiarity with Medical Coding, Medical terminology, CPT‚ ICD9‚ and HCPCS codes
- In depth knowledge of health care terminology, clinical records charting and practices
- Detail oriented, excellent verbal and written communication skills
- Effective collaborative and proven process improvement skills
- Ability to successfully plan, organize and manage projects
- Ability to work in both team and independent settings at all levels of the organization
Associate Degree in Health Care Administration, Cardinal Stritch University, Wisconsin, WI