More than 30 years in the Health Care Industry performing Managed Care Functions in Utilization Management, Finance/Audit, Provider Contracting and Education. Twelve years at Blue Cross and Blue Shield of Florida (BCBSFL) working with Hospital staff and Providers ensuring timely and appropriate care for members. A self-starter with extensive experience in planning and maintaining strong working relationships with Physicians and Senior staff in all settings and levels of the organization. Compliance with laws, regulations, agencies, policies and procedures. Demonstrated effectiveness and high degree of initiative in leading staff in daily operational processes and continuous improvement projects. Consistently exceeded expectations in performance evaluations. Excellent interpersonal, organizational and communication skills. HSS, Miami, Florida Denials and Appeals Coordinator November 2018 - Present * Responsible for utilization chart reviews and approving claims for release from the Bill Hold Report. Assist with review of medical record documentation to resolve inquiries generated by insurance companies, patients, and administration. Serves as Liaison for Denials Management and Bill Hold Release

Highlights:

• Documentation
• Coding
• Medical
• Medical Records
• Medication Adherence
• Patient Care
• Filing
• Management
• Health Care Industry
• Utilization Management