Courtney Boston
Nashville,TN
Summary
As compliance-focused professional, brings valuable experience in navigating intricate appeals and dispute resolution procedures. Known for collaborating effectively with team members to achieve high-quality outcomes and adapt to evolving regulatory requirements. Skilled in analytical problem-solving and efficient case management, ensuring timely and accurate resolutions.
Overview
16
16
years of professional experience
Work History
Appeals Specialist
Blue Cross & Blue Shield of SC
03.2024 - Current
- Managed appeals process for denied claims, ensuring compliance with regulatory standards.
- Collaborated with healthcare providers to gather necessary documentation for appeal evaluations.
- Analyzed complex claim data to identify trends and improve appeals outcomes.
- Facilitated communication between departments to expedite resolution of appeal cases.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
Sr. Provider Contract and Research Management Specialist
United Healthcare
02.2017 - 01.2022
- Researched provider contracts for regulatory fee schedules and services.
- Composed excel spreadsheets to track any trends with provider accounts and practices.
- Led cross-functional teams to implement process improvements enhancing operational efficiency.
- Reviewed and updated client correspondence files and database information to maintain accurate records.
- Consistently met deadlines and delivered high-quality work, demonstrating a strong commitment to excellence in data management.
- Assisted in meeting regulatory requirements by ensuring proper documentation and adherence to data governance policies.
Member Service Representative
Kaiser Permanente
08.2014 - 12.2016
- Provided exceptional customer support by addressing inquiries and resolving issues efficiently.
- Educated members on available services and health plan options to enhance their experience.
- Maintained accurate member records within internal systems, ensuring compliance with privacy regulations.
- Collaborated with healthcare teams to streamline communication and improve service delivery processes.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
Senior Insurance Data Specialist
Assurant Specialty Property
08.2009 - 07.2014
- Managed database systems ensuring integrity and accessibility of critical information.
- Analyzed insurance claims for accuracy and compliance with company policies.
- Mentored junior staff on best practices for claims management and customer service excellence.
- Followed up on denials, late payments, extensions and other special circumstances.
- Resolved discrepancies in insurance payments by collaborating with carriers.
- Researched and resolved routine and complex issues.
- Educated clients on insurance policies and procedures.
Education
B.A. - Psychology
Clark Atlanta University
Atlanta, GASkills
- HIPAA compliance
- Effective communication
- Strong analytical skills
- Medical terminology
- Data entry proficiency
- Teamwork and collaboration
- Multitasking
- Claims adjustment
- Insurance claim forms review
Timeline
Appeals Specialist
Blue Cross & Blue Shield of SC
03.2024 - Current
Sr. Provider Contract and Research Management Specialist
United Healthcare
02.2017 - 01.2022
Member Service Representative
Kaiser Permanente
08.2014 - 12.2016
Senior Insurance Data Specialist
Assurant Specialty Property
08.2009 - 07.2014
B.A. - Psychology
Clark Atlanta University
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