CHRISTIE GMACH
Remote-,VA
Summary
Detail-oriented professional specializing in grievance and appeals resolution and regulatory compliance seeking a Grievances & Appeals Representative 3 role on the Urgent Inquiry Team. Manages multiple high-priority cases with accuracy and efficiency while mentoring team members to enhance collaboration and continuous improvement.
Overview
2027
2027
years of professional experience
Work History
Grievance Appeals Specialist 3
Humana Insurance
Remote-VA
2022 - Current
- Analyze and resolve complex grievance appeals, ensuring compliance with regulatory standards.
- Display excellent time management skills while managing multiple high-priority cases concurrently without compromising quality or attention to detail. Meet/exceed department expectations including Quality/Production/Attendance.
- Provide training and mentorship to new team members, fostering a collaborative work environment focused on continuous improvement.
Medical Scheduler
Kelly Services For Women's Health Services
11.2021 - 12.2021
- Managed secure transfer of medical information and document uploads, ensuring adherence to privacy regulations within EHR system.
- Coordinated and organized daily appointments and schedules for physicians to enhance patient care delivery.
- Optimized workflow to reduce backlog and enhance processing efficiency, resulting in a one-week lead time.
- (Temporary)
Patient Services Specialist
Johnson Health Center
01.2020 - 05.2020
- Demonstrated exceptional customer service in person and by phone to foster welcoming and professional environment for patients.
- Streamlined insurance verification processes for faster resolution of billing issues, resulting in increased revenue collection.
- Coordinated communication between patients, healthcare providers, and administrative staff to improve service delivery.
Customer Service Representative Contractor-Remote
Vaco For Genworth Financial
2020 - 2021
- Provided outstanding customer support via inbound and outbound calls, faxes, and emails in a fast-paced environment.
- Utilized multiple computer applications and tools to efficiently process customer resolutions.
- Executed precise document processing to achieve production targets effectively.
Enterprise Scheduler II
Centra Health
2017 - 2020
- Managed scheduling processes for mammography screenings via phone, fax, and email to optimize patient flow and service delivery.
- Delivered exceptional service to internal and external colleagues, facilitating order acquisition through phone and email communications.
- Streamlined workflow processes by ensuring accurate validation and attachment of physician orders to patient records, supporting departmental operations.
Education
Associate of Occupational Studies - Business
Miller-Motte Technical College
Lynchburg, VASkills
- Call Center Customer Service and Healthcare Industry Experience
- Medicare
- Medical Terminology
- Microsoft Word and Excel
- MHK (MedHok) experience
- Data Entry
- Attention to detail
- Verbal, written, and listening communication skills
- Document processing
- Time management
Certifications & Licenses
Humana Preservice SME (Subject Matter Expert) Certification 207870
Timeline
Medical Scheduler
Kelly Services For Women's Health Services
11.2021 - 12.2021
Patient Services Specialist
Johnson Health Center
01.2020 - 05.2020
Grievance Appeals Specialist 3
Humana Insurance
2022 - Current
Customer Service Representative Contractor-Remote
Vaco For Genworth Financial
2020 - 2021
Enterprise Scheduler II
Centra Health
2017 - 2020
Associate of Occupational Studies - Business
Miller-Motte Technical College