Summary
Overview
Work History
Education
Skills
Timeline
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Nicole Turner

Chicago Heights

Summary

Dynamic and compassionate healthcare professional with over 15 years of hands-on experience in diverse settings. Recognized for accountability and a steadfast commitment to enhancing patient wellness, consistently prioritizing quality care and patient satisfaction. Eager to leverage expertise in developing and implementing innovative healthcare improvement processes and streamlined admission procedures to drive operational excellence and elevate patient outcomes. Passionate about fostering a collaborative environment that promotes continuous improvement in healthcare delivery.

Overview

27
27
years of professional experience

Work History

Senior Complaint and Appeals Analyst

CVS Healthcare
02.2020 - Current
  • Investigated and resolved complex complaints and appeals effectively.
  • Conducted weekly meetings for State Complaints, ensuring timely communication.
  • Maintained and updated State Complaint spreadsheet daily to track progress.

Grievance and Appeal Coordinator

IlliniCare Health
11.2017 - 02.2020
  • Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
  • Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
  • Prepare response letters for member and provider complaints, grievances and appeals and maintain files on individual appeals and grievances

Complaint and Appeals Analyst

Aetna, Inc.
07.2004 - 11.2016
  • Responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues and may require coordination of responses from multiple business units.
  • Research claim processing logic to verify accuracy of claim payment, member eligibility data, billing/payment status, prior to initiation of appeal process
  • Ensure timely, customer focused response to complaints/appeals.

Inbound Queue Associate

Aetna, Inc.
04.2003 - 07.2004
  • Responsible for intake and triage for appropriate healthcare management.
  • Performs non-medical research including eligibility verification, COB, and benefits verification.
  • Supports the administration of the precertification process in compliance with various laws and regulations, URAC and/or NCQA standards, where applicable, while adhering to company policy and procedures.

Accounts Receivable Clerk

Spherion
04.2001 - 01.2003
  • Perform accounts receivable activities with an assigned area, in support of IBM’s CRS objectives of collections and customer satisfaction.
  • Verifies invoices for distribution to customers and/or appropriate personnel to accurately reflect status.
  • Perform file maintenance of customer accounts.

Customer Service Representative

Midwest Suburban Publishing
03.1999 - 04.2001
  • Answered questions and resolved issues based on phone/letters from subscribers.
  • Proactively identified and addressed subscriber educational needs.
  • Focused on gathering information needed to identify problems and achieve best solutions.

Education

Associate in Applied Science Degree - Business Administration

Robert Morris College
Orland Park, IL
01.2001

Master of Arts in Organization Management - HealthCare Administration and Human Resources Management

Ashford University
Clinton, IA
01.2011

Bachelor of Business Administration - Management Concentration

Robert Morris College
Orland Park, IL
01.2009

Skills

  • Appeals and Grievance management
  • Regulatory compliance
  • Documentation review
  • Claims analysis
  • Record maintenance
  • Teamwork and collaboration

Timeline

Senior Complaint and Appeals Analyst

CVS Healthcare
02.2020 - Current

Grievance and Appeal Coordinator

IlliniCare Health
11.2017 - 02.2020

Complaint and Appeals Analyst

Aetna, Inc.
07.2004 - 11.2016

Inbound Queue Associate

Aetna, Inc.
04.2003 - 07.2004

Accounts Receivable Clerk

Spherion
04.2001 - 01.2003

Customer Service Representative

Midwest Suburban Publishing
03.1999 - 04.2001

Master of Arts in Organization Management - HealthCare Administration and Human Resources Management

Ashford University

Bachelor of Business Administration - Management Concentration

Robert Morris College

Associate in Applied Science Degree - Business Administration

Robert Morris College

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