Aaliyah Mitchell
Jacksonville
Summary
Dedicated and detail-oriented professional with 3+ years of experience in remote claims management and healthcare operations. Proven track record in accurately processing claims, ensuring compliance with industry regulations, and delivering exceptional customer service. Proficient in utilizing healthcare software and collaborating with cross-functional teams to optimize claims processes. Seeking a remote claims/healthcare position to contribute to the success of a progressive healthcare organization.
Overview
5
5
years of professional experience
Work History
Claims Specialist
PSR
10.2022 - 05.2023
- Processed an average of 30 claims per day, ensuring accuracy and adherence to company guidelines and industry regulations.
- Utilized claims management software to track and monitor claims status, communicate with stakeholders, and generate reports for management analysis.
- Demonstrated exceptional customer service skills by addressing claim-related inquiries and concerns, resulting in a 90% increase in customer satisfaction ratings.
- Received commendations from team members and supervisors for consistently meeting or exceeding productivity and quality targets.
Appeals and Grievances Coordinator
Arise
03.2018 - 09.2022
- Analyzed and resolved verbal and written claims, medical pre-service appeals, Part D pre-service appeals from both providers and members.
- Analyzed and resolve verbal and written grievances and CTMs from members and legal representatives.
Took verbal grievance and appeals requests from Member Services and/or other departments and migrate to the organization's Appeals & Grievance system for tracking and processing. - Conduct outreach to members and providers for additional information required to resolve grievance and appeals cases. This may involve placing outbound calls or sending faxes or e-mails.
- Analyzed complex cases to determine appropriate resolution in accordance with relevant laws, regulations and organizational policies.
Education
High School Diploma -
Joshua Christian Academy
Jacksonville, FL03-2018
Skills
- Proficient in claims management software and healthcare information systems
- Strong knowledge of medical coding and billing processes (CPT, ICD-10, HCPCS)
- Familiarity with insurance regulations and industry standards
- Excellent analytical and problem-solving skills
- Exceptional attention to detail and accuracy
- Effective written and verbal communication abilities
- Ability to prioritize tasks and meet deadlines in a remote work
environment - Group Health Insurance Administration
- Carrier Enrollment and Data Reconciliation
- Customer Service Excellence
- COBRA and PHI Compliance
- Proficiency in Microsoft Excel and Google Workspace
- Task-Oriented with Strong Organizational Skills
- Ability to Multitask and Prioritize Workload
- Commitment to Confidentiality and Data Protection
- Communication (Written, Verbal, Listening)
- Call Center Operations
- Conflict Resolution
- Time Management
- Compliance (HIPAA)
- Medical and Claim Terminology
- Data Collection and Documentation
- Healthcare Operations
- Spreadsheet and Data Entry
- Call Center Operations
Timeline
Claims Specialist
PSR
10.2022 - 05.2023
Appeals and Grievances Coordinator
Arise
03.2018 - 09.2022
High School Diploma -
Joshua Christian Academy