Michael Cook
Holiday,FL
Summary
Director of administration with significant background in overseeing back office support and management over 5 -year career. Diligently complete in-depth assessments to support VP of Sales, Venders, Clients, Director of I.T., and Director of Operations, requirements with streamlined, logical systems.
Decisive leader with strong project management skills and data-driven approach. In addition, Experienced Medicare Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 8 years of Health experience and willingness to take on any challenge. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. Creative, hands-on professional with expertise in graphic design, art direction and project management.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Appeals Specialist
Novitas Solutions
02.2023 - Current
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
- Improved the appeals success rate by researching legal precedents and staying up-to-date with current industry regulations and guidelines.
- Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
- Maintained high levels of accuracy in all written correspondence, ensuring clear communication with relevant stakeholders during the appeals process.
- Developed strong relationships with healthcare providers, insurance companies, and regulatory agencies to facilitate successful outcomes in the appeals process.
- Demonstrated exceptional attention to detail when evaluating medical records in order to identify discrepancies or inconsistencies that could impact an appeal''s outcome positively or negatively.
Senior Benefit Consultant II
Gohealth LLC
04.2021 - 10.2022
- Licensed in 12 states
- Carriers: United Health Care, Anthem, Humana, Cigna, Aetna, & Well Care
- Selling Medicare advantage plans, Medicare supplement insurance plans, & Stand alone prescription drug plans
- Providing knowledge to customers on insurance plans that will benefit their needs
- Using sale techniques & customer service skills
- Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations
- Determined financial needs by assessing existing coverage and aligning new products and services with long-term goals
- Worked flexible hours; night, weekend, and holiday shifts
- Conducted annual reviews of existing policies to update information.
- Educated employees and retirees about benefit plans and provided clear and efficient assistance.
Director of Operations and Business
The Inner Circle Club, LLC
02.2018 - 09.2020
- Evaluated current service needs and product satisfaction levels with established customers to improve offerings
- Developed short-term and long-term sales objectives and strategic plans to meet market needs
- Developed and implemented value-added strategies to increase profitability, expand market share and cement customer relationships
- Identified and pursued valuable business opportunities to generate new company revenue and improve bottom line profit
- Created vision and provided leadership for targeting larger prospects
- Enhanced marketing exposure through successful website content management and direct correspondence with potential clients
- Enhanced revenues in several programs by implementing creative sales training techniques for staff.
Bar Operations & Marketing Manager
Gulf Coast Management
04.2019 - 03.2020
- Maximized customer service by training staff, overseeing operations and resolving issues
- Closed out cash register and prepared cashier report at close of business
- Created effective employee schedules maintaining coverage at peak times and minimizing labor costs
- Kept alcoholic beverages well-stocked and organized to meet expected demands
- Strategized plans to increase bar revenue through innovative promotional concepts, specialty drinks and customer-focused events
- Adhered to state laws regarding alcoholic beverage services and customer regulations
- Maintained high standards of customer service by staying up to date on bar and menu options and providing effective food recommendations for guests
- Upsold daily specials and beverage promotions to exceed daily sales goals.
Senior Project Coordinator / Director of Administrative Services
SKF Enterprise
01.2014 - 04.2019
- Developed and oversaw project operations and managed multi-functional issues through resolution
- Oversaw business operations and produced updated status reports outlining each project to meet milestones
- Monitored project and program quality to meet audit expectations
- Traveled to other company locations for temporary assignments, meetings or training
- Directed project design functions, developed proposals and conversed with customers and funders
- Oversaw multiple projects simultaneously without sacrificing standards
- Orchestrated wide range of projects, improvement strategies, changes implementation, new revenue stream establishment, and creative marketing and advertising
- Tracked project and team member performance closely to quickly intervene in mistakes or delays
- Reported regularly to managers on project budget, progress and technical problems
- Built successful project plans covering objectives, resources and staffing to meet schedules
- Sourced, vetted and managed vendors needed to accomplish project goals
- Recruited and oversaw personnel to achieve performance and quality targets
- Verified quality of deliverables and conformance to specifications before submitting to clients.
Education
Certified - Film And Video Production
Fred K. Marchman Technical College
New Port Richey, FL01.2010
High School Diploma -
Mitchell High School
2323 Little RD, Trinity, FL 3465501.2010
Skills
- Process development
- Medicare
- Excel
- Photoshop
- Marketing
- Sales/customer service
- Telemarketing sales
- Microsoft Office
- Time Management
- Project Coordination
- Relationship Management
- Customer Relationship Management
- P&L Management
- Labor Cost Analysis
- CRM Software
- Business Development
- Account Management
- Social Media Management
- ICD-10 Codes
- DX Codes
- Project Management
- Operations Management
- Strategic Planning
- Account reconciliation
- Documentation review
- Negotiation
- Verbal and Written Communication
- Documentation Expertise
- Strong Analytical Skills
- Data Entry Proficiency
- Medical Coding Knowledge
Additional Information
- Awarded 1st place in Regional Skills USA
- Awarded 1st place in States Skills USA
- Awarded 1st place in PSA contest
Certification
- Florida 2-40 Health License
Timeline
Appeals Specialist
Novitas Solutions
02.2023 - Current
Senior Benefit Consultant II
Gohealth LLC
04.2021 - 10.2022
Bar Operations & Marketing Manager
Gulf Coast Management
04.2019 - 03.2020
Director of Operations and Business
The Inner Circle Club, LLC
02.2018 - 09.2020
Senior Project Coordinator / Director of Administrative Services
SKF Enterprise
01.2014 - 04.2019
Certified - Film And Video Production
Fred K. Marchman Technical College
High School Diploma -
Mitchell High School