Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Amanda Reese

Tampa

Summary

Detail-oriented and driven healthcare professional with 10+ years of experience in medical documentation, credentialing, and appeals. Adept at coordinating provider enrollment, managing compliance with CMS regulations, and navigating payer systems including QNXT, Facets, and PECOS. Proven track record of leading credentialing teams, managing high-volume appeals under the No Surprises Act, and utilizing platforms such as Salesforce, Verifiable, Zendesk, and MD Staff. Recognized for strong analytical abilities, impeccable attention to detail, and a commitment to organizational integrity and provider satisfaction.

Overview

9
9
years of professional experience
1
1
Certification

Work History

Grievances & Appeals Analyst

BioSpine Institute
05.2020 - Current
  • Submitted and tracked grievance cases and appeals related to NSA balance billing disputes.
  • Utilized CMS reporting tools to support Independent Dispute Resolution (IDR) claims.
  • Interfaced with insurance providers and patients to resolve complex billing appeals.
  • Maintained provider rosters, credentialing applications, and enrollment status in CAQH/PECOS.
  • Supported electronic submission of clean claims and appeals documentation.
  • Used Zendesk and Salesforce for case tracking and resolution communication.
  • Review and analyze denied or unpaid medical claims to determine the reason for rejection and assess the appropriate course of action.
  • Prepare and submit appeals to insurance providers by gathering necessary documentation, medical records and supporting evidence to justify claims.
  • Track and monitor appeals outcomes, ensuring that deadlines are met and claim statues are updated in the system.
  • Collaborated with healthcare providers to gather necessary documentation supporting appeal submissions.

Benefits & Claims Specialist – Appeals and Enrollment Focus

BioSpine Institute
05.2016 - 05.2020
  • Verified insurance benefits and performed high-volume claims reviews and edits.
  • Collected and processed patient liabilities for surgeries and procedures.
  • Submitted and followed up on authorization denials and initiated appeals.
  • Conducted provider verifications and enrollment tasks with Medicare/Medicaid plans.
  • Supported surgical team documentation and compliance needs via NextGen/Epic.

Education

High School Diploma -

Armwood High School
01.2002

Skills

  • Grievances & Appeals (NSA Compliance)
  • CMS Reporting & Independent Dispute Resolution
  • Credentialing & Re-Credentialing (NCQA/CAQH Standards)
  • Provider Enrollment & Primary Source Verification
  • QNXT Facets Xcelys MD Staff Verifiable
  • Salesforce Zendesk PECOS CAQH Availity
  • Leadership & Staff Training Provider Data Integrity
  • Electronic Health Records (EHR/NextGen/Epic)
  • Medical Documentation & Claims Resubmission
  • HIPAA Compliance Audit Support
  • Microsoft Office Suite Salesforce Zendesk MD Staff Verifiable QNXT Facets Xcelys Epic NextGen CAQH PECOS Trizetto Availity Brightree Smart Docs Rivet Spot EHR Systems
  • Strong understanding of medical coding, billing and Insurance procedures
  • Excellent problem solving skills and analytical skills for investigating claim issues

Certification

  • HIPAA Privacy & Security Certified
  • CPR & First Aid Certified
  • CMS No Surprises Act & IDR Training (2023)

Timeline

Grievances & Appeals Analyst

BioSpine Institute
05.2020 - Current

Benefits & Claims Specialist – Appeals and Enrollment Focus

BioSpine Institute
05.2016 - 05.2020

High School Diploma -

Armwood High School

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