Appeals Coordinator Resume Example

Richard Clark

9061 N Brookview Ave

Sacramento, CA, 95833

(555)-555-5555

[email]

Job Objective Seeking an Appeals Coordinator position where I can apply my experience and efficiently contribute to the company’s growth.

Work Experience:

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

Education

Associate Degree in Health Care Administration, Cardinal Stritch University, Wisconsin, WI