Cherrelle Way
Saint Marys,GA
Summary
Proactive and versatile professional with a dedication to quickly adapting to new challenges. Strong problem-solving abilities and a proven track record of fostering strong relationships with clients and team members. Focused on supporting team success and achieving positive results. Offers excellent technical abilities with software and applications, ability to handle challenging work, and excellent time management skills.
Overview
6
6
years of professional experience
Work History
Grievance and Appeals Coordinator
FL Blue
Jacksonville, FL
06.2022 - 02.2025
- Investigated appeals to determine validity of claims and established appropriate action plans.
- Compiled and documented information for appeal cases.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Analyzed data related to denials, recoupment, adjustments to identify patterns or discrepancies.
- Collaborated with physicians, nurses, administrators, and other staff members to resolve issues quickly and efficiently.
- Advised patients and providers on the status of their appeals and any follow-up actions required.
- Maintained records of all appeal activities in a timely manner.
- Answered incoming calls from providers seeking assistance with appeals processing.
- Reviewed denied claims for potential resubmission or reconsideration.
- Conducted comprehensive research and data analysis to support strategic planning and informed decision-making.
Provider Services Specialist IV
Fl Blue
Jacksonville , FL
08.2019 - 06.2022
- Reviewed medical records for coding accuracy according to established guidelines.
- Ensured that all requests from providers were handled in compliance with relevant regulations.
- Investigated appeals from providers regarding payment denials or underpayments.
- Maintained detailed documentation of provider inquiries, complaints, and disputes.
- Maintained professional relationships with healthcare providers.
- Utilized multiple software applications for claims processing, tracking, analysis.
- Collaborated with internal teams such as finance and legal departments when needed..
- Developed relationships with providers and acted as liaison between provider and payer.
Education
Associate of Science - Computer Science
ITT Technical Institute
Jacksonville, FL12-2011
Skills
- Data entry proficiency
- Professionalism and ethics
- Effective communication
- Strong analytical skills
- Continuous learning mindset
- Problem-solving capacity
- HIPAA compliance
- Self motivation
- Task prioritization
- Attention to detail
- Adaptability and flexibility
- Problem-solving abilities
Timeline
Grievance and Appeals Coordinator
FL Blue
06.2022 - 02.2025
Provider Services Specialist IV
Fl Blue
08.2019 - 06.2022
Associate of Science - Computer Science
ITT Technical Institute
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