Ebony Robinson
Riverview,FL
Summary
Dynamic Appeals and Grievances Specialist with a proven track record at Convey Health, excelling in conflict resolution and process improvement. Enhanced member satisfaction through efficient case management and developed standardized documentation templates, significantly expediting resolution times. Proficient in appeals processing and committed to achieving organizational performance metrics.
Personable and highly adaptable, bringing strong analytical abilities and collaborative spirit. Proficient in data analysis and project management, with solid grasp of industry-specific software. Committed to driving impactful results and contributing to team success.
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Overview
2
2
years of professional experience
Work History
Appeals and Grievances Specialist
Convey Health
Fort Lauderdale, FL
08.2024 - 04.2025
- Submit written notification to members.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Contributed to organizational goals by consistently meeting or exceeding established performance metrics related to appeals and grievances management.
- Improved member satisfaction by efficiently managing and resolving appeals and grievances cases.
- Provided outreach for additional information for appeals and grievances.
- Expedited resolution times by proactively communicating with members, providers, and other stakeholders throughout the grievance process.
- Followed all company policies and procedures to deliver quality work.
Glass Claims Processor
Safelight Auto Glass
Columbus, OH
04.2024 - 01.2025
- Utilized specialized software to process incoming claims.
- Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
- Followed up with customers on unresolved issues.
- Reduced claim processing time for faster customer service and improved satisfaction rates.
Insurance Claims Processor
Ashton Carter/WPS
Tampa, FL
10.2023 - 01.2024
- Evaluated and settled complex insurance claims in strict timeframes.
- Increased accuracy in claims processing by verifying policyholder information and cross-referencing with available records.
- Demonstrated exceptional problem-solving skills while handling challenging cases, leading to satisfactory outcomes for both the company and client.
- Maximized claim efficiency by thoroughly reviewing and analyzing insurance claims.
- Evaluated medical records accurately to determine appropriate coverage and payment for claims, leading to increased customer satisfaction.
- Exhibited strong organizational skills in managing multiple tasks simultaneously, resulting in consistently meeting deadlines.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Evaluated accuracy and quality of data entered into agency management system.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Implemented quality assurance processes to check accuracy of claims processing.
- Checked documentation for accuracy and validity on updated systems.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Managed workload and priorities to meet claims processing meet deadlines.
Education
Undergraduate - Medical Billing And Coding
DeVry University
Naperville, IL06-2023
Associate of Science - Medical Billing And Coding
Fortis College
Colorado City, CO04-2013
Skills
- Expert problem solving
- Analytical thinking
- Documentation management
- Proficient in Microsoft Word, Excell, Office, Powerpoint and Outlook
- Teamwork and collaboration
- Multitasking
- Attention to detail
- Organizational skills
- Excellent written communication
- Team and relationship building
- Data analysis
- Project planning
- Decision-making
- Active listening
- Customer relationship management
- Professionalism
- Time management abilities
- Performance metrics
- Conflict resolution
- Reliability
- Issue research
- Quantitative skills
- Effective communication
- Adaptability and flexibility
- Interpersonal skills
- HIPAA compliance
- Insurance verification
- ICD-9 and ICD-10 proficiency
- CMS-1500 form completion
- Medicare and medicaid billing
- Claim submission
- Medical coding expertise
- Diagnostic coding
- Appeals processing
- Procedural coding
- Revenue cycle management
- UB-04 form completion
- CPT coding
- Disability claims process
- Anatomy and physiology
- Medical billing procedures
- HCPCS level II coding
- Claims processing
- Data entry
- Medical billing
- Medical terminology
- Insurance coding (HCPCS & CPT)
- Coding error resolution
- Medical and healthcare claims coding
- Insurance claims analysis
- Inpatient records coding
- Medical record security
- Medicare insurance regulations
- Ethical standards
- Customer service
- EMR systems
- Electronic filing system organization
- Insurance billing and billing procedures
- Patient information verification
- Demographics information
- Compliance verification
- 3M encoder
- Patient rights
- Medical billing code accuracy
- Computerized indexing systems
- Workers' compensation forms
- DRGs patient assignments
- Records maintenance
- Past due account management
- Transcribing
- Patient admission documents processing
- Information analysis
- Electronic health record specialist
Timeline
Appeals and Grievances Specialist
Convey Health
08.2024 - 04.2025
Glass Claims Processor
Safelight Auto Glass
04.2024 - 01.2025
Insurance Claims Processor
Ashton Carter/WPS
10.2023 - 01.2024
Undergraduate - Medical Billing And Coding
DeVry University
Associate of Science - Medical Billing And Coding
Fortis College