ShaQeita Clark
Omaha,NE
Summary
Hardworking Appeals Coordinator bringing over 5 years of experience in sitting at collective bargaining table to resolve conflicts and mediate discussions. Excellent oral and written communication, organizational and problem-solving skills. Looking to apply knowledge and abilities to challenging new role.
Overview
5
5
years of professional experience
Work History
Appeals Coordinator
Magellan Health
Omaha, NE
10.2018 - Current
- Reviewed denied claims for potential resubmission or reconsideration.
- Analyzed data related to denials, recoupments, adjustments to identify patterns or discrepancies.
- Investigated appeals to determine validity of claims and established appropriate action plans.
- Initiated contact with external agencies such as Medicare or Medicaid when necessary.
- Collaborated with physicians, nurses, administrators, and other staff members to resolve issues quickly and efficiently.
- Evaluated medical records to ensure accuracy of diagnoses and treatments.
- Advised patients on the status of their appeals and any follow-up actions required.
- Acted as intermediary between insurance companies and customers by researching and assessing information to determine claim validity.
Education
High School Diploma -
Omaha South Magnet High School
Omaha, NE05-1997
Skills
- Legal Knowledge
- Confidentiality
- Policy Interpretation
- Problem-Solving Capabilities
Timeline
Appeals Coordinator
Magellan Health
10.2018 - Current
High School Diploma -
Omaha South Magnet High School
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