Experienced claims and appeals professional with a strong background in data validation, documentation accuracy, and confidential record handling. Delivers organized case management, compliant workflows, and timely support across high-volume, sensitive environments.
Work History
Medical Management Specialist
5 Years 2 Months
Anthem Blue Cross Blue Sheild | 08.2021 - Current
Confirmed requested data, verified authorization details, and validated medical information release per established procedures.
Executed releases of information requests by ensuring accurate chart retrieval, compliant scanning of medical records, and timely transmission of records in accordance with established procedures.
Supported organizational needs by willingly accepting assignments, assisting additional facilities, and providing coverage during backlog periods.
Data Entry Clerk
2 Years 6 Months
United Healthcare | 02.2019 - 08.2021
Processed high-volume data entry into databases to support data integrity and consistent records.
Verified source documents to maintain data accuracy and corrected discrepancies before system submission.
Maintained organized records filing systems and managed confidential information access to support information governance.
Maintained timely, accurate documentation for all appropriate transactions to support transaction processing.
Appeals Coordinator
1 Year 10 Months
Alignment Healthcare | 04.2017 - 02.2019
Reviewed denied claims and medical records to prepare accurate appeal packages for clinical review.
Interpreted plan policies, CMS guidelines, and internal procedures to support compliant appeal decisions.
Coordinated appeal case intake, verifying member eligibility, benefit coverage, and required documentation.
Tracked appeal deadlines, routed cases to appropriate reviewers, and maintained organized case files.