Nairobi Dunson
Egg Harbor City,NJ
Summary
A detailed oriented professional with 5+ years of experience in the healthcare industry with knowledge in case management, customer service, and contact center support. Seeking a position where I can apply my skills and communication abilities to a team oriented environment. Proven ability to manage complex cases, collaborate across teams, and maintain accuracy in a fast paced environment.
Overview
7
7
years of professional experience
Work History
Reimbursement Case Manager
Cardinal Health
Remote
01.2023 - Current
- Supporting patient access to therapy by eliminating barriers and guiding patients through the enrollment process.
- Making outbound calls to payers to conduct benefit investigations and following up on prior authorization and appeal statuses.
- Educating patients on patient assistance and financial support programs to ensure affordability access and continuity of care.
- Serving as the primary point of contact for patients and healthcare providers, providing ongoing case support and education on available resources.
- Working closely with Field Reimbursement Managers to identify patient barriers, tracking case progress, and coordinating provider support.
Grievance & Appeals Coordinator
Aetna
Remote
02.2022 - 01.2023
- Reviewed and processed a high volume of appeals, ensuring accuracy and timeliness in accordance with CMS guidelines.
- Served as the primary point of contact for members and providers by obtaining missing information and communicating appeal decisions.
- Evaluated all supporting medical records and ensured thorough research for accurate and compliant resolution.
- Prepared and distributed determination and notification letters via mail and fax and maintained strict adherence to regulatory and internal guidelines.
P2P Appeals Coordinator
Corrohealth
Remote
01.2021 - 02.2022
- Scheduled peer to peer reviews with medical directors based on physician availability.
- Made outbound calls to insurance payers to perform denial research and obtain missing information for case coordination.
- Analyzed denial trends to identify root causes and recommend process improvements to prevent recurring issues.
- Maintained professional communication with healthcare facilities and providers to deliver case updates and request additional information as needed.
Health Insurance Agent
Foundever
Remote
11.2018 - 08.2019
- Handled inbound calls from prospective members seeking enrollment into Medicare plans, providing education on benefits, copays, and coverages.
- Verified insurance eligibility and plan benefits for applicants to ensure accurate plan enrollment.
- Acquired doctor and prescription information from applicants to determine coverage eligibility.
- Maintained HIPAA compliance and adhered to established policies to protect customer privacy.
- Developed a strong understanding medical terminology and plan provisions to better assist members during the enrollment process.
Education
Some College in Psychology -
Temple University
Philadelphia, PA01.2021
High School Diploma - undefined
Pleasantville High School
Pleasantville, NJ06.2019
Skills
- Microsoft office
- Health insurance
- Medical terminology
- Data entry
- Salesforce
- Customer Service
Timeline
Reimbursement Case Manager
Cardinal Health
01.2023 - Current
Grievance & Appeals Coordinator
Aetna
02.2022 - 01.2023
P2P Appeals Coordinator
Corrohealth
01.2021 - 02.2022
Health Insurance Agent
Foundever
11.2018 - 08.2019
High School Diploma - undefined
Pleasantville High School
Some College in Psychology -
Temple University