Education
Work History
Skills
Work Preference
Timeline
Generic
Aiyaunda Heath

Aiyaunda Heath

Data Analyst
Montgomery,IL

Education

Bachelor of Science - Software Development

College of Dupage
Glen Ellyn
12-2025

Work History

Appeals and Grievances Coordinator

Centene
Remote, IL
03.2022 - Current
  • Self-motivated, with a strong sense of personal responsibility.
  • Worked effectively in fast-paced environments.
  • Skilled at working independently and collaboratively in a team environment.
  • Proven ability to learn quickly and adapt to new situations.
  • Excellent communication skills, both verbal and written.
  • Worked well in a team setting, providing support and guidance.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Assisted with day-to-day operations, working efficiently and productively with all team members.
  • Passionate about learning and committed to continual improvement.
  • Managed time efficiently in order to complete all tasks within deadlines.

Appeals Analyst

Humana
Remote, IL
02.2019 - 03.2022
  • Mentored new team members on departmental protocols and best practices, fostering a positive learning environment within the team.
  • Communicated complex information clearly to stakeholders, presenting findings and recommendations to guide decision-making processes.
  • Improved the efficiency of the appeals process by reviewing and analyzing claim denials and discrepancies.
  • Leveraged data analysis tools to track performance metrics, identifying trends in case outcomes that informed strategic decision-making efforts.
  • Contributed valuable insights during policy development meetings, integrating an expert understanding of industry regulations into organizational policy changes.
  • Utilized guidelines and review tools to conduct extensive research and analyze grievance and appeal issues.
  • Facilitated cross-departmental collaboration by working closely with clinical staff and legal personnel during case reviews.
  • Conducted thorough research on industry trends, staying informed on best practices for effective appeals management.
  • Conducted ongoing training sessions for staff on regulatory updates and new procedures, ensuring compliance with changing industry standards.
  • Investigated fraudulent activities and recommended corrective actions, safeguarding company resources and maintaining the integrity of the appeals process.
  • Collaborated with interdisciplinary teams to ensure accurate claims adjudication, reducing errors and inconsistencies in the review process.

Provider Relations Specialist

Advocate Physician Partners
Rolling Meadows, Illinois
06.2018 - 02.2019
  • Answered provider inquiries via email, telephone and written correspondence.
  • Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
  • Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
  • Contributed to and enhanced audit processes to maximize quality management standards.
  • Assisted with physician recruitment by identifying specific providers within designated territories, negotiating rates for new physicians and distributing provider agreements.
  • Identified network gaps and collaborated with recruiters to fill deficiencies.
  • Initiated physician and hospital orientations to support ongoing education of health care provider community.
  • Reviewed expenses and fund allocations for accounts at regular intervals to verify credited surplus and deficits based on payment schedules and claim submissions.
  • Played a key role in resolving complex billing issues between providers and payers.
  • Collaborated with internal departments to resolve provider disputes in a timely manner.

Skills

Assertiveness

Teamwork and collaboration

Problem-solving

Attention to detail

Excellent communication

Organizational skills

Adaptability and flexibility

Work Preference

Work Type

Full TimeInternship

Location Preference

Remote

Important To Me

Career advancementWork-life balancePersonal development programsWork from home optionCompany CultureHealthcare benefits

Timeline

Appeals and Grievances Coordinator

Centene
03.2022 - Current

Appeals Analyst

Humana
02.2019 - 03.2022

Provider Relations Specialist

Advocate Physician Partners
06.2018 - 02.2019

Bachelor of Science - Software Development

College of Dupage

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Aiyaunda HeathData Analyst