Summary
Overview
Work History
Education
Skills
Timeline
Generic

Cheronda Battle

Harrisburg,NC

Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Resourceful and adaptable individual with extensive experience handling complex issues, meeting strict deadlines and adjusting to rapidly changing conditions. Willingness to take on added responsibilities to meet team goals.

Overview

11
11
years of professional experience

Work History

Grievance Coordinator

Cigna Healthcare
01.2023 - Current
  • Research and resolve incoming electronic appeals, complaints and grievances as appropriate as a 'single-point-of-contact' based on type of case
  • Can identify and reroute inappropriate work items that do not meet appeal, complaint and grievance criteria as well as identify trends in misrouted work
  • Prioritized workload efficiently, managing multiple cases simultaneously without compromising on quality or accuracy.
  • Demonstrated excellent attention to detail while handling sensitive client information, ensuring confidentiality at all times.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Maintained accurate records of all verifications performed, ensuring easy access and retrieval when required by audit or management review.
  • Assemble all data used in making denial determinations and can act as subject matter expert with regards to unit workflows, appeals, complaints and grievances processes and procedures
  • Can review a clinical determination and understand rationale for decision
  • Able to research claim processing logic and various systems to verify accuracy of claim payment, member eligibility data, billing/payment status, and prior to initiation of the appeal process
  • Serves as point person for newer staff in answering questions associated with claims/customer service systems and products
  • Educates team mates as well as other areas on all components within member or provider/practitioner appeals, complaints and grievances for all products and services
  • Coordinates efforts both internally and across departments to successfully resolve claims research, SPD/COC interpretation, letter content, state or federal regulatory language, triaging of appeals, complaints and grievances, and similar situations requiring a higher level of expertise
  • Identifies trends and emerging issues and reports on and gives input on potential solutions
  • Delivers internal quality reviews, provides appropriate support in third party audits, customer meetings, regulatory meetings and consultant meetings when required.
  • Established positive relationships with internal departments, enhancing cooperation when resolving cross-functional grievances.
  • Cultivated a collaborative work environment with team members, fostering efficiency in addressing grievances.
  • Communicated effectively with diverse clientele, demonstrating empathy and professionalism in addressing their grievances.
  • Enhanced grievance resolution rates by implementing efficient tracking and monitoring systems.

Patient Connection Specialist

Atrium Healthcare
02.2022 - 03.2023
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
  • Responded to customer requests for products, services and company information
  • Utilizes a telephone answering platform to answer calls for multiple areas as indicated in efficient and effective manner using standard greetings for opening of call, content/protocols related to call and closing of call
  • Maintains expert working knowledge of database applications while ensuring patient privacy
  • Works as a team player, while consistently achieving departmental goals and metrics
  • Facilitate patient requests in a safe manner
  • Engages active listening and critical thinking skills to identify caller needs and effectively processes all calls per appropriate service line guidelines
  • Developed strong client relationships through consistent communication and attentive service.
  • Optimized customer experience by delivering superior services and effectively troubleshooting issues.

Workers' Compensation Specialist

OrthoCarolina
08.2016 - 12.2021
  • Acts as an liaison for physicians and coordinates peer to peer reviews in support of worker's compensation approval process
  • Represents OrthoCarolina when working closely with Case Managers, Insurance Adjusters, and employers to ensure that injured workers are cared for efficiently
  • Continuously develops professional relationships with all customers, including but not limited to staff, Physicians, patients, case managers, adjusters, attorneys, other medical providers, NC Medical Society, and NC Industrial Commissions
  • Communicate regularly with worker's compensation clients advising of treatment protocols
  • Seek their input for understanding and inclusion to processes
  • Work with Rehab Rules Committee to advise of rules that need to be addressed or revamped in order to ensure compliance from providers
  • Work with Medical Society and Industrial Commission regarding issue of reimbursement
  • Also must keep informed of issues that providers are facing
  • Collects and/or confirms patient demographic/insurance information as required, and enters data accurately into department's scheduling system
  • Provide general worker's compensation training to physicians and staff
  • Assist in creation of worker's compensation internal policies and procedures and provide general worker's compensation training to physicians, managers and staff
  • Coordinated daily with Patients, Staff, Nurse Case Managers, Insurance Adjusters, Employers for medical procedures/cases for designated department, including medical procedure directives from faxes, phone, or other instructions, and contacts doctors' offices to resolve discrepancies.

Customer Service Representative II

OrthoCarolina
08.2016 - 12.2021
  • Answer and respond to inbound calls from patients and insurance carriers regarding billing and claims concerns
  • Coordinate with other departments, and insurance carriers, to resolve escalated issues, and inform patients of outcome
  • Assist patient in proper payment arrangements to ensure balances are up to date and current
  • Work to collect balances due on each patient account and alert patients of account aging to prevent outside collection action
  • Review reasons for appeals and begins appeal process to capture maximum reimbursement according to provider contracts, government and/or third party payer guidelines
  • Analyze patient's accounts and medical record chart to ensure proper coding such as CPT-4, ICD-9CM and ICD-10CM codes along with place of service and provider codes are prior to re-filing claims to appropriate insurances companies
  • Oversee benefit polices and coverage details through commercial and government insurance agencies.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Acted as liaison between healthcare providers and insurance companies; resolved disputes quickly while maintaining positive relationships.
  • Determined appropriateness of payers to protect organization and minimize risk.
  • Fostered strong relationships with clients, providing personalized service and assistance on various insurance products.
  • Fielded customer complaints, escalating complex issues to management for resolution.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Submitted cash and check deposits and generated cash receipts to record money received.
  • Coordinated with other departments to ensure accurate application of payments, credits, and adjustments to client accounts.
  • Prepared and mailed invoices to customers, processed payments, and documented account updates.
  • Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.

Customer Service Representative

Key Benefit Administrators
08.2014 - 05.2016
  • Coordinate with other departments to resolve escalated issues, and inform customers of proper procedures to follow
  • Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
  • Followed up with customers about resolved issues to maintain high standards of customer service.
  • Review and stay up to date on policies, procedures, and best practices
  • Fostered strong relationships with clients, providing personalized service and assistance on various insurance products.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Educated customers on available discounts, promoting loyalty and policy retention through tailored recommendations.
  • Participated in ongoing training sessions to remain current on industry developments and improve overall job performance.
  • Consistently met or exceeded performance goals related to both sales targets and customer service metrics.
  • Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.

Patient Case Coordinator

The Lash Group
08.2013 - 05.2014
  • Processed incoming enrollment forms to determine eligibility for Patient Assistance Program
  • Worked closely with Medicare Part D patients; ensuring understood their benefit parameters
  • Followed up with patients and healthcare providers via phone, mail, and/or fax if additional information was needed
  • Maintained positive relationships with providers, office contacts, patients, and team members
  • Referred patients to appropriate support services based on operating procedures.
  • Supported patients in navigating complex healthcare systems by providing clear explanations of available resources, benefits, and options.
  • Streamlined communication for better patient outcomes by fostering strong relationships with healthcare providers and insurance companies.
  • Increased patient satisfaction by addressing concerns promptly and providing comprehensive information on treatment plans.
  • Maintained a high level of professionalism when interacting with external parties during the verification process.
  • Prioritized workload efficiently, managing multiple cases simultaneously without compromising on quality or accuracy.
  • Provided clear explanations of complex processes to clients, ensuring their understanding and satisfaction with our services.

Education

No Degree - Business Administration

Georgia Perimeter College
Decatur, GA

High School Diploma -

Frederick Douglass High School
Atlanta, GA
06.1995

Skills

  • Research reporting
  • Call center experience
  • Billing Adjustments and Refunds
  • Mediation Techniques
  • Creative Thinking
  • Closing tickets
  • Verifying coverage
  • Effective Communications
  • Data Entry
  • Cross-Functional Collaboration
  • Document and Records Management
  • Order and Refund Processing

Timeline

Grievance Coordinator

Cigna Healthcare
01.2023 - Current

Patient Connection Specialist

Atrium Healthcare
02.2022 - 03.2023

Customer Service Representative II

OrthoCarolina
08.2016 - 12.2021

Workers' Compensation Specialist

OrthoCarolina
08.2016 - 12.2021

Customer Service Representative

Key Benefit Administrators
08.2014 - 05.2016

Patient Case Coordinator

The Lash Group
08.2013 - 05.2014

No Degree - Business Administration

Georgia Perimeter College

High School Diploma -

Frederick Douglass High School

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Cheronda Battle