Greer Wheeler-Richard
Clayton,NC
Summary
Professional healthcare advocate with 10+ years of experience in healthcare. Services include Customer Service, Utilization Management, facilitator of independent reviews, medical records reviewer for ICD-10 and CPT codes. Ability to build rapport with clients and employees using strong written and verbal communication skills.
Overview
22
22
years of professional experience
Work History
MEMBER LIAISON
A-LINE STAFFING
Chicago, Illinois
10.2023 - 02.2024
- Served as focal contact for Ambetter members’ claim and enrollment issues.
- Used multiple systems to determine member status, claim status and provider affiliations to facilitate rich plan coverage for members.
- Initiated broker-agent fraud claims.
DATA COLLECTION SPECIALIST
GREENE RESOURCES
Raleigh, North Carolina
01.2023 - 10.2023
- Responsible for meeting weekly target (on ten patients) for collection of demographic data for separately billing providers.
- Interviewed medical office personnel to collect patient medical data (ICD-10 codes, CPT codes, charges, payments and adjustments) fo Medical Expenditure Panel Survey project.
- Researched and confirmed provider and facility demographic information for use during separately billing doctors (SBD) year-end cycle.
APPEAL CASE MANAGER
FIDELITY INVESTMENTS
Durham, North Carolina
08.2002 - 06.2021
- Managed second level appeal research, data collection and presentation to the Plan Administrator for final appeal determination.
- Maintained appeal tracking log used to ensure appeals were completed in a timely manner and according to ERISA guidelines.
- Trained new team members on appeal research process; 2 new team members per year on average.
Education
High School Diploma -
John Marshall High School
Rochester, WA06-1982
Skills
- Communication
- Client Advocate
- Compassion
- Customer Satisfaction
- Case Management
- People Skills
- Project Management
- Teamwork
- Quality improvement
- Staff Development
- Training Material Development
- Microsoft Suite
- Google Applications
- ERISA Compliance
- ICD-9 Utilization
- CPT Codes
Accomplishments
- Awarded Fidelity company shares for consistent, outstanding performance and team leadership shown.
Languages
Spanish
Elementary
References
References available upon request.
Timeline
MEMBER LIAISON
A-LINE STAFFING
10.2023 - 02.2024
DATA COLLECTION SPECIALIST
GREENE RESOURCES
01.2023 - 10.2023
APPEAL CASE MANAGER
FIDELITY INVESTMENTS
08.2002 - 06.2021
High School Diploma -
John Marshall High School
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