Experience

Bottom Line Systems

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Managed Care Analyst

  • Jul 2015 - Present

  Review managed care contracts against healthcare claims, to identify underpayments. Examine medical claims and calculate reimbursement based on contract terms. Prepare and submit correspondence such as appeal letters, online inquiries or provider adjustments forms in order to obtained proper reimbursement. Collaborate with healthcare providers, insurers, and policyholders to gather necessary documentation and information for claims resolution. Utilize data analysis tools and software to detect discrepancies, inconsistencies, and potential fraud in claim submissions. Achieved a 98% accuracy rate in claims processing, significantly reducing claim dispute rates and ensuring timely reimbursements. Actively participate in continuous training and development programs to stay updated on evolving healthcare laws and industry standards. Show less



Humana

• United States
• Insurance
• 700 & Above Employee

• Production Lead (G&A department)

  • Jul 2013 - Feb 2015

  Supervised work of associates to ensure resources are managed effectively to meet production and complete all tasks. Used coordination and planning skills to achieve results according to schedule. Completed paperwork, recognizing discrepancies, and promptly addressing for resolution. Oversaw daily operations to ensure high levels of productivity.

• Grievance And Appeals Specialist

  • Aug 2009 - Jul 2013

  Received and processed 20-25 customer grievances and/or appeals in a systematic and accurate manner. Communicated professionally and empathetically with members to gather additional information and clarify their concerns. Evaluated appeal documentation, ensuring completeness while adhering to industry regulations and compliance standards. Ensured all grievances and appeal processes followed established guidelines and legal requirements. Continually maintained quality and compliance scores of 98% or above. Prepared and maintained accurate documentation for regulatory reporting and audits. Analyzed grievances and appeals to determine appropriate courses of action for resolution. Provided clear and concise responses to customers, explaining decisions and outcomes effectively. Show less

• Commercial and Medicare Customer Service Specialist

  • Feb 2007 - Aug 2009



GLA Collections

• Louisville, Kentucky Area

• Medical Collection Specialist

  • Jan 2005 - Feb 2007