Anthea Bonifacio, CPhT
Norwalk,CA
Summary
Dynamic Senior Appeals Coordinator with UnitedHealthcare, skilled in expert communication and regulatory compliance. Achieved significant process improvements by analyzing appeal trends and mentoring staff, enhancing team performance. Proven ability to manage complex cases efficiently while delivering exceptional customer service and maintaining meticulous documentation standards.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Senior Appeals Coordinator
UnitedHealthcare
Cypress, CA
11.2021 - Current
- Coordinated complex appeals processes to ensure compliance with regulatory requirements.
- Analyzed appeal trends to identify opportunities for process improvement and enhanced accuracy.
- Collaborated with cross-functional teams to streamline workflows and reduce turnaround times on appeals.
- Mentored junior staff in best practices for handling appeals, fostering a culture of continuous learning.
- Mentored new hires, sharing expertise and insights gained from years of experience as a Senior Appeals Coordinator, contributing to overall team success.
- Ensured regulatory compliance by staying current with industry updates and adjustments to relevant laws and policies.
- Provided exceptional customer service by addressing concerns empathetically while remaining focused on achieving positive outcomes for the company.
- Reduced backlog of pending appeals through effective prioritization and time management strategies.
IRE Appeals Coordinator Part C and Part D
UnitedHealthcare
Cypress, CA
12.2018 - 11.2021
- Managed appeals process for complex cases, ensuring timely resolutions and adherence to regulatory requirements.
- Collaborated with cross-functional teams to improve communication on appeal outcomes and case statuses.
- Developed training materials for staff, enhancing understanding of appeals procedures and compliance standards.
- Analyzed appeal data trends to identify areas for process improvement and efficiency gains.
Certified Pharmacy Technician
OptumRx
Cypress, CA
12.2015 - 12.2018
- Managed medication dispensing processes to ensure accuracy and compliance with regulations.
- Assisted pharmacists in patient consultations, enhancing medication understanding and adherence.
- Trained new pharmacy technicians on operational procedures and safety protocols.
- Implemented inventory management practices, reducing discrepancies and improving stock levels.
Education
High School Diploma -
Santa Fe High School
Santa Fe Springs, CAPharmacy Technician -
UEI College
Anaheim, CASkills
- Expert communication
- HIPAA compliance
- Medical terminology
- Data entry proficiency
- Documentation expertise
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Multitasking and organization
- Problem-solving abilities
- Reliability
- Excellent communication
- Adaptability and flexibility
- Decision-making
- Phone and email etiquette
- Microsoft office
- Task prioritization
- Interpersonal skills
- Analytical thinking
- Professionalism
- MS office suite
- Time management abilities
- Support services
- Research and analysis
Accomplishments
- Collaborated with Chris Herrig with addressing questions from the Pre-service escalations Jira Portal.
- Part C and Part D Authorization Discrepancies Project- "Buy and Bill Scenarios" updated numerous authorization cases in AS400 (Rxclaims), PAS or HSR. Issues were resolved allowing the member to receive their medications.
- CPT Code Discrepancy- resolved CPT Code discrepancies that were causing unpaid claims.
- Chemotherapy Authorization - mismatched units in the authorization between MBM Now and HSR. Corrected the HSR authorization and ensuring the member to receive the care they needed.
- Part C Misconfigured Auths- made necessary updates the the authorizations so it will be billed correctly
- ICUE/ HSR mismatch for NaviHealth
- Child Cases
- Dismissal Overturns with Christina Edgerton
- RRD Testing - made sure that the process was working properly by changing the due date to the date the letter was generated. Made sure POM updated the task correctly
- RxClaims Authorization Needing Adjustment- adjusted the authorizations by either Terming the authorization in AS400 and creating an auth in HSR
- Cases needing determination
- Created walk through for the local print process
- Created walk through for the task perform internal business
Certification
- Certified [Job Title], [Company Name] - [Timeframe]
- [Area of certification] Training - [Timeframe]
- [Area of certification], [Company Name] - [Timeframe]
Timeline
Senior Appeals Coordinator
UnitedHealthcare
11.2021 - Current
IRE Appeals Coordinator Part C and Part D
UnitedHealthcare
12.2018 - 11.2021
Certified Pharmacy Technician
OptumRx
12.2015 - 12.2018
High School Diploma -
Santa Fe High School
Pharmacy Technician -
UEI College