Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nikia Chevers

Mansfield,TX

Summary

Seeking Grievance and Appeal Representative role with 13 years of experience in appeals, grievances, and customer service. Proven track record in managing appeals for denied claims and providing administrative support in healthcare settings. Skilled in medical terminology, claims processing, and maintaining high standards of customer satisfaction.

Overview

15
15
years of professional experience

Work History

Quality assurance (promotion)

Conduent
01.2024 - 11.2024
  • Spearheaded the quality assurance initiatives at Conduent, ensuring compliance with industry standards and company policies, leading to a promotion for exemplary performance in enhancing operational efficiency and product integrity.
  • Remote

Medicaid Claims Representative

Aetna
04.2023 - 11.2024
  • Maintained electronic medical records and ensured accurate documentation for medical claim creation and self-pay charge posting.
  • Prepared and submitted electronic claim files in compliance with established protocols.
  • Managed the appeal process for denied claims, achieving resolutions or exhausting all possible options.
  • Remote

Healthcare Advocate

Prudential
03.2021 - 08.2023
  • Managed customer inquiries related to insurance and medication, achieving a customer satisfaction rate exceeding 90%.
  • Processed patient health information requests in compliance with company policies and HIPAA standards, maintaining complete confidentiality and security of records.
  • Conducted analysis of new patient charts to ensure accuracy in documentation and processing of over 30 requests for patient records from multiple sources.
  • Handled inbound and outbound calls with professionalism, meeting productivity expectations and maintaining efficient communication.
  • Remote

Claims Specialist

Pavilion at Creekwood
08.2017 - 12.2019
  • Evaluated and processed claims authorization and intake modifications using CureMD software, ensuring accuracy and efficiency within a 48-hour timeframe.
  • Coordinated and researched claim documentation to support prompt payment resolution.
  • Conducted written and verbal communications with over 30 patients to collect necessary information for claim completion.
  • Hybrid Remote

Support Escalations Specialist

Harris Hospital
01.2010 - 08.2018
  • Evaluated patient qualifications for government healthcare programs, ensuring compliance with regulatory standards.
  • Assisted patients with Medicaid/Medicare applications to promote thorough understanding and accurate completion.
  • Provided tailored financial guidance, facilitating patient access to essential healthcare services.

Education

High School Diploma - undefined

Polytechnic High School
Fort Worth, Texas
06.1994

Skills

  • Knowledge of medical terminology
  • Understanding of health insurance
  • Case management practices
  • Problem-solving techniques
  • Empathetic approach
  • Efficient time management
  • Proficient in Microsoft Outlook, Excel, and Word
  • Familiarity with Slack and Salesforce
  • Detail-oriented mindset
  • Claims processing expertise
  • Data entry capabilities
  • Billing and coding in healthcare
  • Strong analytical abilities
  • Communication proficiency
  • Interpersonal effectiveness

Timeline

Quality assurance (promotion)

Conduent
01.2024 - 11.2024

Medicaid Claims Representative

Aetna
04.2023 - 11.2024

Healthcare Advocate

Prudential
03.2021 - 08.2023

Claims Specialist

Pavilion at Creekwood
08.2017 - 12.2019

Support Escalations Specialist

Harris Hospital
01.2010 - 08.2018

High School Diploma - undefined

Polytechnic High School

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Nikia Chevers