Hi, I’m
Chiara Coppola
Brooklyn,NY
Summary
Friendly, seasoned Expedited Grievance & Appeal Specialist with excellent planning and problem solving abilities. Offering 6 years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
8
years of professional experience
Work History
EmblemHealthNew York City, NY
Expedited Appeals Specialist
05.2023 - Current
Job overview
- Independently prepare well written, customized responses to all correspondence that appropriately and completely address the complainant's issue(s) and are structurally accurate in accordance with NCQA, CMS, State, and other regulations
- Managed intricate and time-sensitive expedited appeals, involving complex scenarios, multiple hand-offs, and stringent deadlines
- Conducted meticulous analysis of submitted Power of Attorney and Appointment of Representative paperwork to ensure its integrity, completeness, and accuracy prior to acceptance
- Serve as liaison with EmblemHealth departments, delegated entities, medical groups, and network physicians to ensure timely authorization effectuation and resolution of cases
- Meet administrative expense budget targets by attaining and exceeding performance metrics for Grievance and Appeals with emphasis on accuracy, quality, timeliness and implementing efficiencies
- Create and document service requests to resolve issues and ensure all document requirements are satisfied
New York City, NY
Grievance & Appeal Specialist
05.2017 - 05.2023
Job overview
- Provided written acknowledgment and determination for all member and provider appeal and grievances
- Using internal systems, determine eligibility, benefits, and prior activity related to the claims, payment, or service in question
- Performed comprehensive inquiries autonomously, examining the matters at hand and obtaining responses and information from both internal and external stakeholders
- Served as contact with EmblemHealth departments, delegated entities, medical groups and network physicians to ensure timely resolution of cases
- Prepared cases for medical, dental and administrative review detailing the findings of their investigation for consideration in the plan’s determination
BLA PartnersBurlington, VT
Reimbursement Analyst
05.2015 - 02.2017
Job overview
- Diligently followed up with insurance to ensure receipt, proper processing and tracked outstanding payment issues
- Reviewed denials on EOB/ERAs to work issues until resolved for maximum reimbursement
- Analyzed accounts receivable reports to follow up on unpaid claims
- Maintained all additions, terminations, and changes to insurance plans as appropriate
- Resolved routine patient billing inquires, handling follow-up questions from patients and resolving discrepancies or errors
- Expedited the filing of appeals and corrected/clean claims
- Researched rejections, investigating problems to appeal claims.
- Maintained confidentiality and integrity of patient data.
Education
Southern New Hampshire University
Master of Science from Business Administration
04.2023
Castleton University, Castleton State College
Bachelor of Science from Business Administration
05.2011
Skills
- Microsoft Office
- Critical Thinking
- Strategic Analysis
- Time Management
- Power BI
- Teamwork and Collaboration
- Data Entry
- Verbal and Written Communication
- Organizing and Prioritizing Work
- Attention to Detail
Timeline
Expedited Appeals Specialist
EmblemHealth
05.2023 - Current
Grievance & Appeal Specialist
05.2017 - 05.2023
Reimbursement Analyst
BLA Partners
05.2015 - 02.2017
Southern New Hampshire University
Master of Science from Business Administration
Castleton University, Castleton State College
Bachelor of Science from Business Administration
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