Appeals Coordinator Resume

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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