Megan Gaffney
Harrisburg,PA
Summary
Healthcare administration professional holding a Bachelor of Science in Healthcare Administration and currently pursuing graduate-level studies. Extensive experience supporting regulatory appeals, healthcare operations, and secure patient information management through the use of Microsoft Office Suite, SharePoint, Adobe Acrobat, and enterprise healthcare systems including MACESS, Metavance, and PEGA. Skilled in data management, workflow optimization, reporting, compliance, and cross-functional collaboration. Combines technical proficiency with strong analytical and communication skills to support efficient and compliant healthcare operations.
Overview
12
12
years of post-secondary education
9
9
years of professional experience
Work History
Triage Coordinator, Regulatory and Appeals Department
Delta Dental of Pennsylvania
01.2023 - Current
- Developed and implemented a comprehensive "Regulatory Triage Job Aid" to standardize appeal workflows, enhancing team consistency and streamlining onboarding for complex coverage inquiries.
- Manage high-volume regulatory and member appeals processes, ensuring compliance with state and federal healthcare mandates.
- Collaborate with internal departments to aggregate data, ensuring clinical workflow interoperability and accurate reporting.
- Streamline internal tracking processes for appeal backlogs, significantly improving turnaround times and member satisfaction.
- Serve as a primary point of contact for resolving complex coverage inquiries, translating clinical policy into actionable administrative outcomes.
Appeals and Grievances Specialist
Capital Blue Cross
01.2019 - 01.2023
- Led complex appeals and grievances cases, ensuring adherence to strict CMS and state regulatory requirements.
- Identified trends in member complaints to improve service delivery and communication strategies.
- Promoted from Customer Service based on exceptional performance and mastery of health insurance benefit administration.
Customer Service Representative
Capital Blue Cross
01.2019 - 12.2019
- Provided comprehensive support to members regarding benefits, eligibility, and claim statuses in a high-volume environment.
Clinical Assistant / Nurse’s Aide, Medical-Surgical Unit
UPMC Pinnacle
01.2018 - 01.2019
- Provided direct patient care in a fast-paced medical-surgical environment, supporting nursing staff in delivering high-quality, patient-centered care.
- Maintained meticulous patient records and supported clinical documentation processes, ensuring data integrity for care teams.
- Applied clinical understanding to support workflow efficiency and interdisciplinary communication.
Education
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
10.2024 - 07.2026
Associate of Applied Science -
Harrisburg Area Community College
Harrisburg, PA 06.2008 - 05.2018
Central Dauphin East High School
Harrisburg, PASkills
Technical Skills
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
- Microsoft Outlook
- Microsoft Teams
- Microsoft OneNote
- Microsoft SharePoint
- Adobe Acrobat
- Data Management & Reporting
- Electronic Document Management
- Healthcare Information Systems
- Workflow Documentation & Process Improvement
Healthcare Software
- MACESS
- Metavance
- PEGA
- Appeals and Grievance Management Systems
- Secure Patient Information Management
- Regulatory Tracking Systems
Professional Skills
- Regulatory Compliance
- Quality Improvement
- Data Analysis
- Customer Service
- Team Collaboration
- Conflict Resolution
- Process Improvement
- Analytical Thinking
- Professional Communication
- Attention to Detail
Timeline
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
10.2024 - 07.2026
Triage Coordinator, Regulatory and Appeals Department
Delta Dental of Pennsylvania
01.2023 - Current
Appeals and Grievances Specialist
Capital Blue Cross
01.2019 - 01.2023
Customer Service Representative
Capital Blue Cross
01.2019 - 12.2019
Clinical Assistant / Nurse’s Aide, Medical-Surgical Unit
UPMC Pinnacle
01.2018 - 01.2019
Associate of Applied Science -
Harrisburg Area Community College
06.2008 - 05.2018
Central Dauphin East High School