Summary

Overview

Work History

Education

Skills

Additional Information

Timeline

Hi, I’m

Kally McFee

Lewiston,ID

Summary

Dedicated Member Appeals professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Overview

years of professional experience

Work History

Cambia Health Solutions- Regence

Member Appeals Lead

05.2022 - Current

Job overview

Trained new team members by relaying information on company procedures and requirements.
Worked different duties to provide optimal coverage and meet production goals.
Prepared detailed reports on updates to project specifications, progress, identified conflicts during the unexpected backlog
Evaluated employee skills and knowledge regularly, training and mentoring individuals with lagging skills.
Established open and professional relationships with team members to achieve quick resolutions for various issues.
Mentored newly hired employees on processes and developed training manual to use for reference.
Continuously check for quality assurance according to strict guidelines.

Cambia Health Solutions- Regence

Member Appeals Specialist II

11.2017 - 05.2022

Job overview

Acted as Member Appeals subject matter expert, answering internal and external questions and inquiries.
Developed appeals functions, policies and procedures, and documentation.
Modified, updated and processed existing policies.
Created, composed and maintained appeal response templates.
Checked documentation for accuracy and validity on updated systems.

Cambia Health Solutions- Regence

Member Appeals Specialist I

01.2011 - 12.2017

Job overview

Verified client information by analyzing existing evidence on file.
Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Coordinated with Other Internal and Peer Reviewer Departments to compose appeal responses.
Completion and notification of determination to members and business partners with excellent verbal and written communication skills
Responded to attorney inquiries and litigation notices.
Provide education and assistance to the appellant and business partners
Organized workflow with the ability to meet quality, quantity, accuracy and appeal timeframes and guidelines
Acted as a departmental resource on appeals matters.
Acted as eviCore subject matter expert, answering internal and external questions and inquiries.

Cambia Health Solutions- Regence

Medical Management Appeals Analyst

09.2010 - 01.2011

Job overview

Triage, Validate, and Input data into Provider Appeals systems for Appeals handling
Maintained accuracy, completeness and security for medical records and health information.
Utilized Provider Reimbursement Methodologies to accurately handle Appeals

Cambia Health Solutions- Regence

Ambassador, Member Services Correspondence

02.2008 - 09.2010

Job overview

Analyze, evaluate and prepare Member Appeal cases for Medical Review and communication decisions to appellant and business partners
Written correspondence to include e-mails, written letters, and pre-authorization requests to provide information, education and assistance
Perform Correspondence duties while being back-up support for: Resource Desk, Core Phones, Live Help Chat, Front Counter and also served as Correspondence Trainer

Cambia Health Solutions- Regence

Member Services Specialist

06.2006 - 02.2008

Job overview

Delivered exceptional customer service to every customer by leveraging extensive knowledge of benefits and services and creating welcoming, positive experiences.
Investigated and resolved customer inquiries and complaints quickly.
Responded proactively and positively to rapid change.

Boys & Girls Clubs of the Lewis Clark Valley

Youth Development Director

05.2002 - 06.2006

Job overview

Exposed youths to variety of sports activities and encouraged participation.
Planned and implemented wide-ranging programs, encapsulated learnings and fielded inspirational guest speakers.
Developed and introduced cultural and ethnic diversity programs.

Lewis-Clark State College

College Women's Basketball Assistant Coach

05.2001 - 05.2002

Job overview

Led practice sessions with players practicing drills, honing techniques and scrimmaging to put practiced skills into play.
Coordinated with head coach and experienced players to develop curriculum and play book.
Assisted head coach with recruiting of new players by attending scouting events and games.
Counseled athletes on conflict resolution techniques and anger management to improve on-court and off-court behaviors.

Education

University of Idaho
Moscow

Master of Science from Sports and Recreation Management

05.2003

University Overview

Lewis- Clark State College
Lewiston, ID

Bachelor of Science from Kinesiology

05.2001

University Overview

Skills

Health Care System
Quality Standards
Complex Problem-Solving
Documentation and Recordkeeping
Staff Training
Strategic Planning

Organizational Policies
Attention to Detail
Continuous Development
Leadership
Peer Relationships
Team Member Motivation, Teamwork and Corroboration