Lakesha Todd
Calera,AL
Summary
Demonstrate strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Bring positive attitude and commitment to continuous learning and growth.
Overview
12
12
years of professional experience
Work History
Appeals Coordinator
Blue Cross and Blue Shield of Alabama
11.2019 - Current
- Assess, manage, and reply to appeals from both members and providers.
- Make the final determinations on all benefit appeals
- Adhere to the guidelines and timelines established by ERISA, Department of Labor regulations, CMS, the Blue Cross and Blue Shield Association Inter-Plan processing, and NCQA.
- Collaborate with various departments within the organization, including Claims, Health Management, Legal, Benefit Administration, and Provider Networks.
- Draft outgoing correspondence as guided by Health Management to address pre-service and post-service determination inquiries from providers and members.
- Evaluate, investigate, and respond to Health Insurance Casework System (HICS) complaints directed to the organization by CMS.Review, process and respond to member emails
- Address general correspondence related to a range of topics and issues.
- Review, manage, and respond to emails from members.
Customer Relations Specialist
Blue Cross and Blue Shield of Alabama
10.2012 - 11.2019
- Provide assistance to physician office staff and patients with benefits, billing and claims questions
- Special Project: Senior Resource Line (SRL)- coach and advise reps and receive supervisory calls
- Train and mentor new hires
- Review and resolve claims issues
- Execute first call resolution
- Provide backup support to claims division
- Identify operational issues and trends
Education
B.S. - B.S.B. Health Administration
Faulkner Unoversity
Montgomery, AL12-2024
Skills
- Appeal process
- Claim review
- Customer communication
- Appeal resolution
- Patient advocacy
- Quality assurance
- Time management
- Problem solving
- Attention to detail
- Workflow management
- Policy interpretation
- Claim analysis
- Decision making
- Benefit analysis
Summary of Knowledge
- Research and Analytical skills
- Problem solving and time management skills
- Excellent oral and written communication skills
- Utilize independent judgement and decision making
- Managing multiple projects with various priorities
Timeline
Appeals Coordinator
Blue Cross and Blue Shield of Alabama
11.2019 - Current
Customer Relations Specialist
Blue Cross and Blue Shield of Alabama
10.2012 - 11.2019
B.S. - B.S.B. Health Administration
Faulkner Unoversity
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