Summary
Overview
Work History
Skills
Education
Timeline
Certification
Kellie Thiner

Kellie Thiner

Atwater,Ca

Summary

Professional appeals specialist prepared for roles that demand high standards and effective communication. Extensive experience in managing complex member appeals within the healthcare sector. Strong analytical and problem solving skills, with excellent writing and grammar and knowledgeable of state and federal guidelines.


Overview

31
31
years of professional experience
1
1
year of post-secondary education

Work History

Senior Complaint and Appeals Coordinator

Aetna
02.2024 - Current
  • Completed in-depth investigations into member non-clinical complaints and appeals and followed state and federal guidelines and Aetna's policies and procedures to resolve member appeals in compliance with state timelines.
  • Prepared clinical cases and routed to appropriate departments.
  • Created, composed and maintained appeal resolution responses.

SR Service Advocate - Ops

Aetna, CVS Health
01.2022 - 02.2024
  • Answer member calls promptly with professionalism.
  • Answer questions regarding medical, dental, and pharmacy benefits.
  • Research and resolve complex claims issues, Coordination of Benefits, refill too soon RX requests and many other member issues by reaching out to providers, billing offices, employers, and collection agencies and advocating for the member.

Insurance Biller

American Medical Response
01.2017 - 01.2022
  • Reviewed non emergency ambulance transports for medical necessity.
  • Verified and billed commercial insurances as well as Medicare and Medicaid HMO’s
  • Obtained all pertinent information from patient care report and input all data including medical codes and patient chief complaint or symptoms.
  • Obtained patient demographics for emergency transports on John Doe’s by utilizing Lexus Nexus and Payor Logic.
  • Followed all Medicare and Medicaid guidelines and Hipaa rules and regulations.

Pharmacy Clerk

Savemart Pharmacy
08.1994 - 02.2003
  • Took prescription refill request
  • Answered phones
  • Obtained treatment authorizations
  • Handled cash and credit card payments.

Skills

  • Efficient spreadsheet maintenance
  • Skilled in advanced MS Office applications
  • Accurate data entry
  • Strategic problem analysis
  • Experienced in QuickBooks software
  • Excellent communications skills
  • Experienced in handling multi-line calls
  • Strong attention to detail
  • Data processing
  • Customer service orientated
  • Policy interpretation
  • Insurance regulations
  • HIPAA compliance
  • Strong analytical skills

Education

No Degree - Medical Assistant

Galen College of Medical And Dental Assistants, Modesto, CA
07.1990 - 02.1991

Timeline

Senior Complaint and Appeals Coordinator - Aetna
02.2024 - Current
SR Service Advocate - Ops - Aetna, CVS Health
01.2022 - 02.2024
Insurance Biller - American Medical Response
01.2017 - 01.2022
Pharmacy Clerk - Savemart Pharmacy
08.1994 - 02.2003
Galen College of Medical And Dental Assistants - No Degree, Medical Assistant
07.1990 - 02.1991

Certification

Medical Assisting

Galen College Of Medical Assistants

Modesto, CA 1991

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