Jasmine Graddick
Belleview,FL
Summary
Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.
Overview
12
12
years of professional experience
Work History
Appeals & Grievance Resolution Specialist
AmeriHealth Caritas
Remote
07.2025 - Current
- Resolved complex appeals by coordinating multidisciplinary teams and analyzing case details.
- Streamlined appeals & grievance processes, enhancing response times and ensuring compliance with regulatory standards.
- Conducted in-depth investigations into complaints, ensuring thorough documentation and reporting.
- Analyzed grievance trends to identify systemic issues, recommending actionable improvements to management.
- Maintained accurate records of all grievance cases, facilitating easier reporting and analysis of trends.
- Developed tailored strategies for unique grievance situations that led to customer satisfaction while maintaining compliance with company policies.
- Took notes on interviews and other workplace investigations, compiled records and organized documentation for cases.
- Analyzed appeal cases to ensure compliance with regulatory standards and internal policies.
- Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
- Coordinated appeals process, ensuring compliance with regulatory requirements and organizational policies.
Utilization Management Technician
AmeriHealth Caritas
Remote
06.2022 - 07.2025
- Reviews patient medical records: Analyzes clinical information, treatment plans, and other relevant data to evaluate the appropriateness and necessity of services
- Ensures compliance with insurance guidelines: Adheres to pre-authorization and other utilization management requirements set by various payers.
- Maintains accurate records: Keeps detailed and organized records of patient information, utilization reviews, and related documentation within the medical management system.
- Collaborates with healthcare teams: Works closely with physicians, nurses, and other healthcare professionals to address patient needs and ensure optimal care.
- Applies clinical experience, health plan benefit structure, health management policies and procedures, and claims payment knowledge.
Personal care connector
Amerihealth Caritas
Philadelphia, PA
10.2018 - 06.2022
- The Care Connector is responsible for supporting the daily operations of integrated care management and utilization management program interventions
- The Care Connector performs in a contact center environment, effectively processing calls from Members, Providers and other areas, internal and external to the company
- The CC identifies members with Care Gaps/HEDIS related health conditions and assists them in accessing care through Plan benefits and community resources
- Under the direction of Clinical staff, the Care Connector will provide members with educational materials and carry out strategies to increase health care adherence and reduce barriers to care
Outreach Coordinator
Health Partners Plans
Philadelphia, PA
06.2014 - 06.2018
- Reviews and track predetermination status of members to identify appropriate level of intervention required to promote the continuous enrollment of qualified members
- Conducts telephonic outreach to members to educate on important Medicaid eligibility renewal requirements
- Assist members with completing online renewal applications for the Medicaid program to assure compliance with deadlines
- Conduct telephonic outreach to new members to advise them of their benefits;
- Educates members on various programs (through Disease Management and SNU) available to them, if applicable; and ensure that all pertinent documentation (ID cards, handbooks, etc) has been received
- Assists with scheduling PCP visits for some new member populations as mandated by DPW within the appointment Standards
- Maintains accurate record of outbound call attempts, inaccurate telephone numbers, messages left, and successful outreach activities
- Documents call activities in both On Contact and Macess to ensure accurate reporting
- Perform other duties as assigned
Education
High School Diploma -
Samuel Fels High School
Philadelphia, PA, USASkills
- HIPAA compliance
- Insurance verification
- Quality improvement
- Healthcare regulations
- Utilization review
- Medical necessity assessment
- Inpatient care
- Medicare
- Medicaid
- Outpatient care
- Effective communication
- Strong analytical skills
- Medical terminology
- Insurance policies
- Grievance handling
- Appeals handling
- Time management
- Problem resolution
- Claims investigation
- Decision-making
- Task prioritization
- Prior authorization processing
- Document review
- Medical terminology knowledge
- Workflow management
- Claim research
- Medical coding
- Quality assurance practices
- CPT coding
- Customer service
- Retro-authorizations
- Insurance procedures
- Benefit coverage
- Authorizations
- ICD-10 coding
- Pharmacy utilization review
- DME utilization review
- MRI utilization review
- Behavioral health utilization review
Timeline
Appeals & Grievance Resolution Specialist
AmeriHealth Caritas
07.2025 - Current
Utilization Management Technician
AmeriHealth Caritas
06.2022 - 07.2025
Personal care connector
Amerihealth Caritas
10.2018 - 06.2022
Outreach Coordinator
Health Partners Plans
06.2014 - 06.2018
High School Diploma -
Samuel Fels High School