Megan Carlton
Polk City,FL
Summary
Exceptional team building skills with an aptitude for building rapport with a diverse range of customers, managers, and colleagues; talent for quickly resolving issues prior to escalation. Seeking to leverage my technical and professional expertise to grow in a new role. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
5
5
years of professional experience
Work History
Appeals Specialist
Conduent
07.2019 - Current
- Researched complex cases involving multiple parties or multiple issues to provide accurate decisions on appeals.
- Collaborated with provider relations staff to resolve disputes between providers and health plans concerning payment for services rendered.
- Ensured all documents are stored securely according to HIPAA standards.
- Advised customers on best practices for submitting complete documentation along with their appeal requests.
- Responded promptly and professionally to customer inquiries via phone, email or fax.
- Demonstrated strong problem solving skills when resolving difficult customer service issues.
- Inquiry within other departments to insure accurate bill review inquires.
- Reviewed appeals submitted by patients and providers to ensure accuracy and compliance with policies.
- Analyzed medical records to determine if further information was needed in order to process appeals.
- Assisted customers with the appeals process, including providing guidance on how to submit an appeal.
- Prepared written responses for customer inquiries regarding their appeals status.
- Coordinated with internal departments to ensure timely resolution of appeals.
- Maintained up-to-date knowledge of applicable laws, regulations, policies and procedures related to appeals processing.
Education
Certificate -
Bob Hogue School of Real Estate
01.2014
Diploma -
Armwood High School
01.2008
Skills
- Energetic work attitude
- Strong organizational skills
- Active listening skills
- Adaptive team player
- Telephone inquiries specialist
- Customer service expert
- Data Entry
- Teamwork and Collaboration
- Small Claims Payouts
- 10-Key Touch
- Decision-Making
- Attention to Detail
Timeline
Appeals Specialist
Conduent
07.2019 - Current
Certificate -
Bob Hogue School of Real Estate
Diploma -
Armwood High School