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Mutual Health Services - Appeals Processing Coordinator II Resume Example

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Gabriel Rodriguez
XXXXX XXXXXXXX XXX XXXX , Strongsville , OH 44136 | (H) XXXXXXXXXXXX | XXXXXXXXXXXXXXXXXX
Professional Summary

Seasoned Appeals Processor with more than 17 years of experience in fast-paced healthcare insurance industry. Excellent research and investigational skills. Track record of achieving exceptional results in multi-level provider and member Appeal Processing reviews.

Skills
  • Economics and Accounting
  • Critical Thinking
  • Reading Comprehension
  • Complex Problem Solving
  • Judgment and Decision Making
  • Coordination
  • Time Management
  • Law and Government
  • Customer and Personal Service
  • Production and Processing
Experience
Appeals Processing Coordinator II 04/2006 to Present
Mutual Health Services Strongsville, OH
Investigates, researches, analyzes and respond to routine and non-routine provider and member appeal inquiries.  Utilize in depth claims adjudication knowledge and skills, resolve complex correspondence issues, override claims requiring higher level of security and manual calculations for problematic cases.
Internal Auditor 08/1998 to 04/2006
Central Reserve Life/Ceres Group Strongsville, OH

Reviewed and released claim holds for compensation upon the verification that processes and procedures were completed within company and mandated guidelines. 

Assisted in procedural updates in accordance with state and federal mandates as appropriate.

Education
High School Diploma: General Jun 1989 Strongsville High School - Strongsville, OH
Community Service

Highly active in the charitable events and activities in support of:

  • National MS Society
  • JDRF
  • The Breast Cancer Research Foundation
  • The Leukemia & Lymphoma Society
  • Walk For Wishes
  • Rainbow Babies & Children's Hospital
  • American Heart Association
  • Camp Ho Mita Koda
  • Berea Animal Rescue Fund
  • ABATE Ohio
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    Resume Details

    This is a real resume for a Appeals Processing Coordinator II in Strongsville, Ohio with experience working for such companies as Mutual Health Services, Central Reserve Life, Ceres Group. This is one of the hundreds of Appeals Processing Coordinator II resumes available on our site for free. Use these resumes as templates to get help creating the best Appeals Processing Coordinator II resume.

    Previous Companies:

    • Mutual Health Services
    • Central Reserve Life
    • Ceres Group

    Previous Job Positions:

    • Appeals Processing Coordinator II
    • Internal Auditor

    Schools:

    • Strongsville High School

    Level of Education:

    • High School Diploma

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