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
Nashville, TN
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
Atlanta, GA
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
Atlanta, GA
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
Duluth, GA
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