- Audited Medicare Advantage claims for coding accuracy, benefit payment, contract interpretation, and compliance with CMS policies and procedures.
- Administered advanced and highly specialized administrative/operational/customer support duties that required independent initiative and judgment.
- Delivered associate-specific feedback that identified procedural and compliance opportunities.
- Quality Subject Matter Expert for Medicare Advantage Pre-Service and Expedite case types.
- Presented and facilitated meetings including the segmentation and creation of slide presentations.
- Member of the Resolution Team Engagement Committee.
- Member of the 2021 CPSS Diversity Council where I co-created a successful pilot that supported the growth and development of frontline associates.

- Analyzed and provided quality monitoring of Pre-Service, Expedite, and Post Service appeal cases, in addition to Internal Review Team cases, for members enrolled in Medicare Advantage plans.
- Reviewed procedural documentation and provided feedback when potential compliance risks
were identified.
- Quality Subject Matter Expert for Medicare Advantage Pre-Service and Expedite appeal cases including developing a training resource and instructing new hires.
- Created and presented an interactive excel presentation highlighting excel tips.
- Joined the team Engagement Committee in November of 2020.

- Provided internal and external assistance with the denial, reconsideration and appeal process for
HGB comprehensive and clinical review.
- Prepared cases for the external reviews of initial and reconsideration determinations.
- Researched and facilitated responses to DHA/NQMC inquiries which included authorization information, claims information, and medical records.
- Provided claims research for medical records, modifiers, adjustments, and allowable charges.
- Assisted Team Lead with training new hires throughout various stages of the training process.
- Streamlined the departmental procurement responsibilities including supply orders and Medical Review Company payments (i.e., Payment processing, Excel sheet management).
- Co- administrator of departmental templates for policy manual revisions.

- Effectively answered inbound calls on the TRICARE program utilizing available resources and information systems.
- Championed the customer’s needs and perspectives.
- Resolved customer service issues in a professional and courteous manner.
- Prioritized workload to continuously answer incoming calls and maintain established schedules and deadlines.
- Consistently accountable by meeting expectations and quality standards.