Open To Work
Ruth Perea
Work Preference
Summary
Resilient Appeals and Grievances Coordinator known for high productivity and efficient task completion. Possess specialized skills in policy interpretation, dispute resolution, and regulatory compliance. Excel in communication, problem-solving, and negotiation, ensuring successful outcomes in complex situations.
Overview
1
1
Language
15
15
years of professional experience
Work History
Appeals and Grievances Coordinator
Presbyterian Health Plan
Albuquerque, New Mexico
11.2017 - 07.2025
- Coordinated appeals process for member grievances at Presbyterian Health Plan
- I have 35 years of experience with Health Care. With Lovelace Health Plan for 25 years. (Got laid off when we lost the bid for Medicaid)
- Did referrals, processed claims (both member and provider) Provider Network Management (worked provider contacts) auditor for high dollar claims. Appeals and Grievance, worked member appeals and mostly member grievances (led specialists) also did Fair Hearings w/ the State. Worked for Molina Health Care for 6 years got laid off then went to Presbyterian Health Plan worked from 2018-2025 and took a year off and ready to go back. Have lots of Health Care experience.
Appeals and Grievances Coordinator
Molina Healthcare
Albuquerque, NM
06.2010 - 09.2017
- Coordinated appeals process for member grievances at Presbyterian Health Plan.
- Reviewed and analyzed member claims and appeal requests for compliance.
- Facilitated communication between members and healthcare providers regarding disputes.
Education
Albuquerque High School
Albuquerque, NM Skills
- Appeals coordination
- Claim processing
- Dispute resolution
- Compliance analysis
Languages
English
Professional
Timeline
Appeals and Grievances Coordinator
Presbyterian Health Plan
11.2017 - 07.2025
Appeals and Grievances Coordinator
Molina Healthcare
06.2010 - 09.2017
Albuquerque High School