DOLORES KEELER
Espyville,PA
Summary
Experienced Analyst with over 10 years of proven success in healthcare office operations. Known for consistently resolving complex problems, improving customer satisfaction, and driving operational success. Effective communicator within team environments and with individuals. Skilled in creating and delivering critical documents, reports, and data. Exceptional time management abilities, adept at multitasking and prioritizing high-level duties to meet deadlines. Proficient in Microsoft Office applications.
Overview
16
16
years of professional experience
Work History
Medicare Part C Senior Appeal Analyst
Aetna Healthcare
10.2015 - Current
- Quality and Review all cases for errors
- Assist with inventory oversight to ensure all cases are resolved within CMS compliance timeframe
- Perform second look of cases submitted for AOR, POA, EOE, Good Cause and PWOL
- Dismiss all appeals that do not meet Medicare Advantage guidelines
- Train and coordinate staff in appropriate workflows with live examples and real-time coaching
- Review cases for potential compliance risks
- Maintain an open line of communication with Supervisors/Management about business/team/personal topics daily
- Research incoming complaints/appeals to identify trends and areas of opportunity
- Analyze claim processing logic to verify accuracy of claim billing/payment status
- Validation of member eligibility and benefits as well as provider participation with our network of plans
- Assisted in the preparation for audits and government inquiries
- Consistently compliant with all HIPAA practices and standards as well as the handling of protected health information
- Collaborate across multiple lines of business to develop new strategies and present fresh ideas necessary to drive efficiency as well as production.
Benefits Quality Analyst
SDLC Partners
04.2013 - 03.2015
- Reviewed Health, Dental, and Vision benefits for accuracy
- Identify trends with quality issues
- Manage special projects.
Hemophilia/IVIG Specialist
Vantage Home Healthcare
01.2009 - 01.2010
- Worked closely with patients to ensure excellent and direct individualized patient care
- Established relationships with patients
- Always maintained confidentiality of patient data and condition to safeguard health information
- Delivered excellent patient experiences
- Connected patients with available community and charitable resources.
Education
Bachelor’s degree - Health Informatics
Ashford University
San Diego, CAAssociates Degree - Health Information Technology Management & Coding
Bryan University
Tempe, AZ10.2012
Certification - Computer Technology
Parkway Vo-Tech
Oakdale, PA01.1994
Skills
- Analytical Thinking
- MS Excel
- Team Collaboration and Leadership
- Documentation And Reporting
- Project Management
- Excel proficiency
- Data Research and Validation
- Data Processing
- Teamwork and Collaboration
- Problem-Solving
- Multitasking Abilities
- Organizational Skills
References
Available upon request
Timeline
Medicare Part C Senior Appeal Analyst
Aetna Healthcare
10.2015 - Current
Benefits Quality Analyst
SDLC Partners
04.2013 - 03.2015
Hemophilia/IVIG Specialist
Vantage Home Healthcare
01.2009 - 01.2010
Bachelor’s degree - Health Informatics
Ashford University
Associates Degree - Health Information Technology Management & Coding
Bryan University
Certification - Computer Technology
Parkway Vo-Tech
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