Byonne Bavis
Summary
Dedicated professional with over two decades of diverse experience in Appeals & Grievances, insurance verification, and claims processing
Overview
11
11
years of professional experience
Work History
Care Review Processor
Cigna Healthcare
01.2024 - 08.2024
- Participated in interdepartmental integration and collaboration to enhance continuity of care for client members.
- Contacted physician offices to obtain missing information from authorization requests as requested by medical director.
- Increased efficiency in responding to provider inquiries about case status updates or clarifications needed in submitted documents through effective communication techniques.
- Promoted a culture of continuous improvement by actively participating in training sessions, workshops, and professional development opportunities related to care review processing.
Appeals & Grievances Coordinator / Benefits Analyst
UnitedHealth Group
09.2022 - 04.2023
- Conducted 60+ calls on a daily basis
- Reviewed, analysed, and identified trends for appeals, grievances, and retro authorization requests
- Processed and prepared complex referral authorization requests
- Provided expertise and general support to teams in reviewing, researching, investigating, negotiating, and resolving all types of appeals and grievances
- Communicated with appropriate parties about appeals and grievance issues, implications, and decisions
- Tediously processed multiple claims daily
- Audited claims and plans created to make sure they are good to go live
- Installed benefits accurately in the system to ensure claims are paid and benefits are quoted to members
- Met members' needs to access benefits, analyzed benefit information, and coded into various systems
- Offered subject matter expertise on employment regulations, compensation policies and personnel management procedures to optimize internal structures
- Coordinated benefits processing, including enrolments, terminations, and claims
- Provided assistance to plan participants by explaining benefits information to ensure educated selections
- Mastered state and Federal benefit laws Including ERISA, FMLA, COBRA, HIPPA and 401k administration
- Assisted with audits by preparing accounts and providing information
- Evaluated efficiency and value of current benefit programs and made recommendations for improvement
- Kept operations in compliance with requirements by applying knowledge of applicable regulations, legal statutes, and tax code information.
Remote Senior Dispatcher
Marathon Global logistics
03.2020 - 06.2022
- Managed 50-100 inbound and outbound calls a day
- Tracked changes in computer system to keep records current and accurate
- Kept detailed and updated records of calls in physical and electronic databases
- Reviewed routes, traffic, and weather conditions to adjust plans, meeting requirements and service needs
- Embraced, promoted, and led continuous improvement efforts to establish drivers and trucks utilized to maximum potential
- Scheduled loads according to priority and available equipment
- Monitored dispatch board and adjusted call priorities regularly based on caller needs
- Utilized various software systems to facilitate movement, planning and scheduling
- Supervised driver dispatching, route planning and vehicle tracking for over eight drivers
- Monitored changes in delivery schedule and communicated changes to customers
- Worked closely with transportation supervisor to dispatch and assign loads
- Answered customer requests with information about product availability, shipping information and status updates
- Identified locations and needs of callers to accurately send assistance.
Senior Patient Care Coordinator
HealthCare Partners Medical Group
06.2018 - 10.2019
- Completed 50+ calls each day
- Scheduled evaluations, procedures, or classes for patients
- Verified insurance and obtained and checked status of authorizations
- Communicated with patients to ensure quality of care and develop care plans
- Liaised effectively with patients, doctors, and staff members, assessing medical charts, and promoting high level of communication and interaction
- Resolved conflicts between physicians, nurses, and administrative staff to maintain optimal workflows
- Implemented new hire training to further develop skills and initiate discussions on task prioritization.
Appeals and Grievances Coordinator
CalOptima
01.2018 - 03.2018
- Handled 100+ queued calls and 60+ UB04 and 1500 claims regularly
- Completed open enrollment and checked claims and prior authorizations
- Researched disciplinary and grievance issues and recommended optimal courses of action
- Contacted customers to gather information, communicate disposition of case, and document interactions
- Generated written correspondence to customers such as members, providers, and regulatory agencies
- Prioritized and organized tasks to efficiently accomplish service goals.
Workers' Compensation Claims Specialist/Loan Processor
Credit Union
10.2016 - 02.2017
- Examined claims, records, and procedures to grant approval of coverage
- Collaborated with fellow team members to manage large volume of claims
- Organized information by using spreadsheets, databases, or word processing applications
- Prepared and reviewed insurance-claim forms and related documents for completeness
- Input claim information and payments into company database
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
Claims and Appeals Coordinator
Alignment Healthcare
02.2016 - 06.2016
- Performed 50-75 calls and 40-60 physician and hospital claims per day
- Ensured that all insurance information needed for billing and collection processes are appropriately obtained and recorded in the computer system
- Contacted insurances to check eligibility and confirm insurance status via online portals or over the phone
- Informed patients of their financial responsibility for services to be rendered
- Verified all referrals were completed
- Created and maintained business relationships with medical providers
- Managed a wide variety of customer service and admin tasks to resolve issues quickly and efficiently
- Navigated through various databases and programs for updating and maintenance daily
- Verified details with policyholders and requested additional information
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Referral and Appeals Coordinator
UnitedHealth Group
10.2013 - 10.2014
- Conducted 100+ calls on a daily basis
- Reviewed, analyzed, and identified trends for appeals, grievances, and retro authorization requests
- Processed and prepared complex referral authorization requests
- Provided expertise and general support to teams in reviewing, researching, investigating, negotiating, and resolving all types of appeals and grievances.
Education
High School Diploma -
Long Beach Polytechnic High School
Long Beach, CASkills
- Benefits Interpretation
- Appeals & Grievances
- Federal benefit laws
- Claims
- Insurance verification and authorization
- Billing, collections, resolving claims, denials, and appeals
- Checking referrals, and assessing patient records
- Open Enrollment
- Special Projects
- Verbal and Written Communication
- Supervision & Leadership
- Planning & Organizing
- People Skills
- Training & Development
- Computer Skills
- Data Management
- Organizational Skills
- Customer Service
- Team Building
- Good Work Ethic
- Problem Resolution
- Critical Thinking
- ACA Standards Knowledge
- Oracle
- Epic
- NextGen
- ECW
- Cerner
- Centricity
- Meditech
- Citrix
- IDX
- Allscripts
- Kronos
- DrChrono
- MyChart
- Practice EHR
- MS Office
Typingspeed
100%, 88 WPM
Timeline
Care Review Processor
Cigna Healthcare
01.2024 - 08.2024
Appeals & Grievances Coordinator / Benefits Analyst
UnitedHealth Group
09.2022 - 04.2023
Remote Senior Dispatcher
Marathon Global logistics
03.2020 - 06.2022
Senior Patient Care Coordinator
HealthCare Partners Medical Group
06.2018 - 10.2019
Appeals and Grievances Coordinator
CalOptima
01.2018 - 03.2018
Workers' Compensation Claims Specialist/Loan Processor
Credit Union
10.2016 - 02.2017
Claims and Appeals Coordinator
Alignment Healthcare
02.2016 - 06.2016
Referral and Appeals Coordinator
UnitedHealth Group
10.2013 - 10.2014
High School Diploma -
Long Beach Polytechnic High School
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