Sachiko Burns
Columbus,OH
Summary
Supportive Team Lead with over 15 years of experience leading teams. Expert in following detailed production schedules with distinguished history of maximizing productivity. Committed to proactive reorganization for optimized safety and efficiency. Strong analytical and communication capabilities.
Overview
24
24
years of professional experience
Work History
Lead, Grievance and Appeals Coordinator
Buckeye Health Plan
Columbus, Ohio
04.2019 - Current
- Developed monthly and daily production reporting for 10 plus employees to ensure meeting department metrics.
- Audited team performance and compliance for Senior Manager and Leadership minimum 2x week
- Coached team members in techniques necessary to complete job tasks.
- Took on additional job duties during unexpected backlog, resulting in meeting project target date.
- Established open and professional relationships with team members to achieve quick resolutions for various issues.
- Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
- Evaluated employee skills and knowledge regularly, training and mentoring individuals with lagging skills.
- Developed appeals functions, policies and procedures, and documentation.
Grievance and Appeals Coordinator
Buckeye Health Plan
Columbus, Ohio
07.2015 - 04.2019
- Responded to Member, Provider, Ohio Department of Medicaid, Ohio Department of Insurance inquiries and litigation notices.
- Acted as department resource on State Complaint, Grievances and State Hearing matters, policies and procedures, and documentation.
- Coordinated with Department Senior Manager and Manager to compose State Complaint responses of as many as 50 complaints per week.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Communicated effectively with staff members of compliance, claims and clinical departments.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Acted as State Complaint and State Hearing subject matter expert, answering internal and external questions and inquiries.
Senior Case Specialist
CareWorks Of Ohio
Dublin, Ohio
01.2008 - 07.2015
- First Senior Case Specialist for company developing new position.
- Confirmed consultative reports and diagnostic test results for affected employers.
- Scheduled follow-up and rescheduled appointments for injured workers to facilitate safe and fast return to work.
- Determined appropriate examinations, tests and specialists required for each case.
- Performed routine data entry or document management.
- Responded to in-person and telephone requests for information from injured workers, medical providers, Ohio Bureau of Workers Compensation, third party administrators and injured worker attorneys.
- Served as resource for24 team members and other departments within company.
Lead Case Specialist
CareWorks Of Ohio
Dublin, Ohio
01.2005 - 01.2008
- Point of contact for assigned employers totaling over 1000 for team supporting Manager and Case Specialists.
- Scheduled and documented one on one meetings with 15 Case Specialists to ensure metrics were being met.
- Performed routine data entry or document management.
- Stayed up-to-date on Ohio laws and licensing requirements to complete accurate and efficient reviews.
- Recorded and edited minutes of meetings and distributed to appropriate officials or staff members.
- Wrote, reviewed and submitted team auditing reports per week for department records.
Case Specialist
CareWorks Of Ohio
Dublin, Ohio
09.1998 - 01.2005
- Scheduled follow-up and rescheduled appointments for injured workers of case load over 100.
- Worked closely with Employers, Injured Workers, Providers, Attorneys, Third Party Administrators and Ohio Bureau of Workers Compensation representatives to ensure safe and timely return to work statuses for affected workers.
- Performed routine data entry or document management daily.
- Responded to in-person and telephone requests for information from involved parties.
- Created documents with applicant information and verified data against Ohio Bureau of Workers Compensation database information.
Education
Bachelor of Arts - English
John Carroll University
Cleveland, OHSkills
- Medical Documentation
- New Policies Processing
- Communications Strategies
- File Management
- Appeals Support
- Active Listening
- Deficiency Documentation
- Complex Problem-Solving
- Query Escalation
- Employee Evaluation
- Regulatory Compliance Adherence
- Policy and Procedure Explanations
- HIPAA Guidelines
Timeline
Lead, Grievance and Appeals Coordinator
Buckeye Health Plan
04.2019 - Current
Grievance and Appeals Coordinator
Buckeye Health Plan
07.2015 - 04.2019
Senior Case Specialist
CareWorks Of Ohio
01.2008 - 07.2015
Lead Case Specialist
CareWorks Of Ohio
01.2005 - 01.2008
Case Specialist
CareWorks Of Ohio
09.1998 - 01.2005
Bachelor of Arts - English
John Carroll University
Similar Profiles
Retunda CulpepperRetunda Culpepper
Quality Improvement Abstractor and Invoice Processor at Buckeye Health Plan - CenteneQuality Improvement Abstractor and Invoice Processor at Buckeye Health Plan - Centene
PATRICIA R. SPENCERPATRICIA R. SPENCER
Sr. Compliance Administrator at Buckeye Health PlanSr. Compliance Administrator at Buckeye Health Plan
RHONDA HAUSFELDRHONDA HAUSFELD
Compliance Specialist at Buckeye Health PlanCompliance Specialist at Buckeye Health Plan