Charlene Austin
Brooklyn
Summary
Dynamic Appeals Processor with extensive experience at Cigna, excelling in efficient data management and service-oriented communication. Proven track record in resolving complex appeals through meticulous attention to detail and strong interpersonal skills. Recognized for delivering timely outcomes while maintaining compliance, ensuring high standards in documentation review and conflict resolution.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Appeals Processor Senior Representative
Cigna
Remote
04.2024 - Current
- Conduct detailed appeals investigations of supporting documents and systems to determine the appeal outcome.
- Proactively communicated with appellants, the leadership team, providers, and the original case manager to resolve investigation issues, resolve issues, and communicate decisions/rationale for denial or approval.
- Retrieved assigned cases from queue and analyzed issues to determine classification.
- Validate all assigned cases; review appeal documents, correct appeal types, time frames, and what is being appealed.
- Assigned priority levels and due dates based on regulatory compliance timeframes.
- Independently conduct a thorough review of all new provider correspondence by analyzing all the issues presented to determine the appropriate classification.
- Monitored internal deadlines to ensure compliance time frames were consistently achieved.
- Document all steps taken during review for audit compliance.
- Verified that all necessary data was received on schedule by managing daily reports and communications.
- Executed additional responsibilities as delegated.
- Reviewed all non-clinical appeals and validated the accuracy of received information to ensure compliance with standards.
- Demonstrated strong written and verbal communication skills when documenting actions.
- Responsible for maintaining and prioritizing the workload to support appeal timeliness, and to communicate risks, concerns, or opportunities to leadership related to their workload.
Independent Contractor (Data Entry)
Amazon Mechanical Turk
Remote
08.2021 - 02.2024
- Ensures database integrity by updating customer and account data.
- Compiled and organized data to ensure readiness for computer input.
- Ensured correctness and consistency of information entered into systems.
- Validated information by cross-referencing with original data.
- Reviewed and updated client correspondence files and database information to maintain accurate records.
- Obtained scanned records and uploaded them into the respective databases.
- Performed online research to gather pertinent data.
- Produced accurate written transcripts from verbal communications.
Freelancer
Independent Contrator
Remote
03.2018 - 10.2019
- Reviewed client correspondence files and updated database information.
- Resolved inaccuracies in data to prevent subsequent complications.
- Updated and maintained filing systems by adding necessary documents to existing records.
- Reviewed source documents to identify necessary information for data entry fields.
- Secured scanned records and entered data into relevant databases.
- Ensured data accuracy and validity in databases.
- Handled various babysitting responsibilities including organization, meal preparation, and maintaining cleanliness.
- Ensured proper medication administration and adherence to healthcare routines.
Pharmacy Technician
Kmart Pharmacy
New York
06.2016 - 07.2017
- Handled high volume of prescription typing with accuracy.
- Delivered exceptional service while assisting patients at prescription drop-off and pick-up windows.
- Conducted thorough verification of billing records and sensitive healthcare information.
- Executed cashier duties, managed filing tasks, and upheld inventory control.
- Contacted insurance companies to verify customer's coverage and eligibility.
- Responded to inquiries about medication availability and pricing.
- Supported pharmacy operations by answering phone calls and directing queries appropriately.
- Monitored supply inventory and promptly submitted replenishment orders to prevent shortages.
Education
Master of Arts - Psychology
Long Island University
Brooklyn, NY09.2018
Skills
- Efficient Data Management
- Proficient in Microsoft Office
- Word processing
- Independent Problem Solver
- Effective Time Management
- Skilled in Technical Solutions
- Data Analysis in Excel
- Proficient Conflict Resolution
- Strong Interpersonal Skills
- Highly Organized
- Data-Driven Research Proficiency
- Documentation Review
- Analytical Problem-Solving
- Effective Multitasking
- Meticulous Attention to Detail
- Appeals process proficiency
- Service-Oriented Communication
Certification
Medical Billing and Coding
Borough of Manhattan Community College, 2022
Timeline
Appeals Processor Senior Representative
Cigna
04.2024 - Current
Independent Contractor (Data Entry)
Amazon Mechanical Turk
08.2021 - 02.2024
Freelancer
Independent Contrator
03.2018 - 10.2019
Pharmacy Technician
Kmart Pharmacy
06.2016 - 07.2017
Master of Arts - Psychology
Long Island University
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