Dakisha Tucker
North Brunswick,NJ
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
19
19
years of professional experience
Work History
Admin. Appeals Processor
Cigna
01.2015 - Current
- Understand and interpret Summary Plan Descriptions and provider contract rates.
- Able to work under strict guidelines and adhere to required turnaround timeframes.
- Exercise good judgement and decision making skills and know when to escalate an issue to a coach.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Self-motivated, with a strong sense of personal responsibility.
- Excellent communication skills, both verbal and written.
- Completes and transfers task in Oneview to the appropriate queues.
- Use of TruCare to review the Nurser Reviewer or Medical Director decisions on cases that require precertification.
- Significant knowledge of Outlook, WebEx, Share drive, Knowledgexchange and Microsoft office applications. Daily updates and interaction with these program to track, update and help with determination of appeals.
- Attend weekly huddle calls with the team to review new or updates on policies and procedure, priorities work load and give input to enhance work flows/polcies. Also a time assist with challenging appeals, input from team and management.
- Resolved medical claims by approving or denying documentation, calculating benefits due, initiating payments and composing denial letters.
Senior Appeals Coordinator
QualCare Inc.
Piscataway, NJ
01.2005 - 12.2015
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Assist the team with their questions and identifies any training needs
- In the absence of the Appeals and Cost Containment Coordinator, responds to Insurance Department, Compliance, Dept of Health and Senior Services, Department of Labor, VIP/Executive, Subpoena and attorney questions, issues and inquires.
- Maintains queues, review and tracks cases due for closure.
- Delegates and assigns task in the supervisor's absence or as a backup.
- Follow up with team members on status of case due for closures.
- Identify root cause, and filter out inconsistencies
- Relate the issue to the client's Summary Plan Description.
- Provider timely assistance to our Members and Providers by addressing their appeals in order to resolve claim issues.
- Respond to and resolve issues and inquiries.
- Track appeals and grievances in an orderly, timely and accurate manner.
- Analyze types of calls via HSP.
- Resolve claim issue and process claims when appropriate appeal is settled and provide support for claims and member services.
Education
Associate of Arts - Accounting
Berkeley College
New York, NY1998
Skills
- Claims Procedures
- Claims Evaluations
- Data Integrity
- Analyzing Claims
- Claims Knowledge
- Client Correspondence
- Status Updates
- Data Entry Software
- Great Mathematical Skills
- Policy and Procedure Explanations
- Office Equipment
Timeline
Admin. Appeals Processor
Cigna
01.2015 - Current
Senior Appeals Coordinator
QualCare Inc.
01.2005 - 12.2015
Associate of Arts - Accounting
Berkeley College