Nora Dirini
Specialist, Provider Appeals & Grievances
Bothell,WA
Summary
Resourceful claims billing specialist offering history of success coordinating and monitoring operations across various departments. Effective leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Highly committed with hardworking mentality to maintain quality of services and products. Demonstrates a friendly demeanor and a continuous pursuit of learning and development. Adaptable to fast-paced settings, adept at working both autonomously and collaboratively within teams.
Overview
9
9
years of professional experience
Work History
Specialist, Provider Appeals and Grievances
Molina Healthcare
04.2024 - Current
- Investigated and resolved provider appeals and grievances in accordance with company policies and regulatory requirements
- Conducted comprehensive reviews of appeals documentation, ensuring accuracy and completeness
- Provided support and guidance to providers throughout the appeals process, maintaining professionalism and empathy
- Compiled and maintained detailed records of appeals and grievances for reporting and auditing purposes
- Participated in training sessions and stayed updated on industry trends and regulatory changes related to provider appeals and grievances.
- Assisted with staff training to enforce quality, compliance, and HIPPA guidelines.
- Performed detailed assessments of claims payments, ensuring precise alignment with provider contracts and HCA fee schedules.
Associate Specialist, Provider appeals and Grievances
Molina Healthcare
05.2020 - 04.2024
- Responsible for processing provider appeals and grievances according to company protocols and regulatory guidelines
- Conducted thorough investigations and assessments of provider appeals, ensuring accuracy and compliance with healthcare regulations
- Collaborated with internal teams to resolve provider issues and ensure timely resolution of appeals
- Maintained detailed records and documentation of appeals and grievance processes
- Participated in training sessions and stayed updated on relevant healthcare laws and regulations
- Received commendation for efficiency and accuracy in handling provider appeals and grievances.
- Maintained calm demeanor and professionally managed issues in busy, high-stress situations.
- Mentored junior staff members, contributing to their professional growth and improved performance.
- Assessed customer needs and utilized suggestive selling techniques to drive sales
Provider Service Clerk
Molina Healthcare
11.2019 - 05.2020
- Managed provider appeals and claims processing, including organizing and processing various claim types/forms (Medicare, Medicaid, & Marketplace).
- Assisted in assigning claims to internal teams, collaborated with other Molina HealthCare locations to address provider issues, and maintain confidentiality of sensitive information.
Receptionist
Molina Healthcare
03.2019 - 11.2019
- Managed member/provider incoming calls and walk-in visitors, maintaining a presentable and organized front office environment
- Contributed to team success by cross-training in various administrative roles, providing backup support when necessary.
Manager
527 Coffee
06.2015 - 03.2019
- Managed a small team of baristas, ensuring high customer service standards, while overseeing day-to-day operations.
Education
A.A. - Integrated Studies
Cascadia Community College
Bothell, WA 05.2001 -
Skills
Volunteer
Green Space environmental clean up with Friends of North Creek Forest
Timeline
Specialist, Provider Appeals and Grievances
Molina Healthcare
04.2024 - Current
Associate Specialist, Provider appeals and Grievances
Molina Healthcare
05.2020 - 04.2024
Provider Service Clerk
Molina Healthcare
11.2019 - 05.2020
Receptionist
Molina Healthcare
03.2019 - 11.2019
Manager
527 Coffee
06.2015 - 03.2019
A.A. - Integrated Studies
Cascadia Community College
05.2001 -
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