Theresa Morrison
West Monroe,LA
Summary
Dynamic Appeals Specialist with proven success at Blue Cross and Blue Shield of Louisiana, adept at navigating the appeals process and ensuring HIPAA compliance. Recognized for exceptional problem-solving abilities and effective communication, consistently achieving positive outcomes through meticulous attention to detail and strong teamwork skills.
Experienced with managing appeals and dispute resolution processes effectively. Utilizes analytical skills to assess and resolve complex cases while ensuring compliance with regulatory standards. Track record of collaborating with teams to deliver timely and accurate outcomes, adapting to changing needs and requirements.
As compliance-focused professional, brings valuable experience in navigating intricate appeals and dispute resolution procedures. Known for collaborating effectively with team members to achieve high-quality outcomes and adapt to evolving regulatory requirements. Skilled in analytical problem-solving and efficient case management, ensuring timely and accurate resolutions.
Overview
23
23
years of professional experience
Work History
Appeals Specialist
Blue Cross and Blue Shield of Louisiana
07.2020 - Current
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
- Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
- Maintained high levels of accuracy in all written correspondence, ensuring clear communication with relevant stakeholders during the appeals process.
- Expedited resolution times for appeals cases by efficiently managing workload and prioritizing urgent matters.
Insurance Specialist
St Francis Medical Center
07.2008 - 07.2020
- Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
- Processed eligibility and benefits verification and authorization requests.
- Tracked pending authorizations to resolve discrepancies and avoid revenue loss.
- Maintained high standards of customer service by building relationships with clients.
- Maintained a high level of industry expertise through continuous professional development courses and certifications in the field of insurance specialty.
- Communicated effectively with members of operations, finance, and clinical departments.
- Maintained confidentiality of patient finances, records, and health statuses.
Front Desk Receptionist
Alexandria Neurosurgical Clinic
01.2006 - 09.2007
- Greeted guests at front desk and engaged in pleasant conversations while managing check-in process.
- Maintained organized and clean front office area to create professional and welcoming environment for visitors and employees.
- Delivered outstanding first impressions by warmly greeting visitors upon arrival at the front desk.
- Managed high-volume phone calls, directing inquiries to appropriate personnel for prompt resolution.
- Enhanced customer satisfaction by providing efficient and professional front desk services.
- Supported administrative tasks such as filing, data entry, and document preparation for more efficient office workflow.
- Handled sensitive customer information with confidentiality, adhering to company privacy guidelines.
- Developed strong working relationships with team members, fostering a positive work environment.
- Completed data entry and filing to keep records updated for easy retrieval.
- Expedited check-in and check-out procedures for guests, ensuring seamless experiences during their visits.
- Resolved customer issues quickly and notified supervisor immediately when problems escalated.
- Completed all tasks in compliance with company policies and procedures.
Insurance Verification Specialist
Pendleton Memorial Methodist Hospital
09.2002 - 08.2005
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Complied with HIPAA guidelines and regulations for confidential patient data.
- Improved communication between medical staff and patients by explaining insurance benefits and financial responsibilities.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Managed high-volume insurance verifications within pressured timeframes for productive medical operations.
- Collaborated with team members to resolve discrepancies in insurance verification, ensuring proper billing practices.
- Assisted patients with understanding personalized insurance coverage and benefits.
- Increased patient satisfaction by promptly addressing concerns regarding insurance coverage or billing issues.
Education
Medical Assistant Class
John Ehret Hight School
Marrero, LA05-1992
Skills
- Organizational growth
- HIPAA compliance
- Effective communication
- Professionalism and ethics
- Medical terminology
- Appeals process proficiency
- Teamwork
- Teamwork and collaboration
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Organizing and prioritizing work
- Organizational skills
- Adaptability and flexibility
- Teamwork skills
- Insurance coverage verification
Timeline
Appeals Specialist
Blue Cross and Blue Shield of Louisiana
07.2020 - Current
Insurance Specialist
St Francis Medical Center
07.2008 - 07.2020
Front Desk Receptionist
Alexandria Neurosurgical Clinic
01.2006 - 09.2007
Insurance Verification Specialist
Pendleton Memorial Methodist Hospital
09.2002 - 08.2005
Medical Assistant Class
John Ehret Hight School
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