Prepared and resolved 50+ written Medicare and HMO grievances/appeals cases in accordance with Federal and State Government Regulations.
Recommend verbally, member-favorable case resolution to Medical Directors based on contract examination.
Collaborate with members and Health Care Providers, Legal Affairs and Government Agencies to amicably resolve all grievance/appeals received daily.
Adherence to mandatory guidelines instituted by Agency for Healthcare Administration (ACHA) and National Committee for Quality Assurance (NCQA) as well as Health Insurance Portability and Accountability Act (HIPPA).
Maintained client relationship throughout enrollment process ensuring client's understanding of guest membership terms by explaining do’s and don’ts of benefits.
Education
Bachelor of Science - Technical Management, Project Management
DeVry University
Miramar, FL
12.2007
Member
American Writers Association Inc.
Boca Raton, FL
Master of Science - Leadership
Nova Southeastern University, Wayne Huizenga School of Business & Entrepreneurship
Davie, FL
12.2013
Skills
Excellent Interpersonal Communication
Writing
Persuasion
Microsoft Office
Idea Brainstorming
Sales and Marketing
Client Relations
Presentations
Time Management
Timeline
Freelancer / Copywriter
Self-employeed
08.2021 - Current
Substitute Teacher, K-12
Kelly Education
03.2014 - Current
Distributor
Saladmaster Inc
08.2009 - 02.2022
Profit Recovery Consultant
Transworld Systems Inc
11.2007 - 07.2009
Grievance and Appeals Coordinator
Blue Cross & Blue Shield of Florida
01.1999 - 10.2007
Bachelor of Science - Technical Management, Project Management
DeVry University
Member
American Writers Association Inc.
Master of Science - Leadership
Nova Southeastern University, Wayne Huizenga School of Business & Entrepreneurship