CGS Administrators - DME MAC Jurisdiction C Redetermination Appeals Analyst Resume Example

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Isaac Wright

XXXX XXX XXXXXXX XXXXX XXX, Hermitage, TN 37076

Ph: XXXXX XXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Professional Summary

Appeal analyst with knowledge of medical terminology and HIPPA compliance. Passionate and motivated with an objective to pursue a career in a professional environment with the possibility of future advancement.

Skills

Active Listening
Customer and Personal Service

Critical Thinking
Time Management

Judgment and Decision Making
Production and Processing

Experience

DME MAC Jurisdiction C Redetermination Appeals Analyst Feb 2013－Present CGS Administrators, LLC － Nashville, TN

Analyzing Medicare DME claim appeals to determine insurance coverage.
Reviewing medical and administrative records to determine the extent of liability.
Generating letters to notify the provider and the beneficiary of their re-determination decision.
Adjusting claims for payment or denial as needed.
Adhering to all metrics as required by company policies and the Centers for Medicare and Medicaid (CMS)

DME MAC Jurisdiction C Tier 1 CSR / CEDI Helpdesk Jan 2010－Feb 2013 CGS Administrators, LLC － Nashville, TN

Handling provider telephone inquiries regarding claims and policies.
Recording details of inquiries, complaints, or comments, as well as actions taken.
Performing research and interpreting policies in order to answer provider inquiries and to further educate providers.
Adhering to company policies, CMS standards, and HIPPA regulations
Assisting providers with electronic claim submission questions through the CEDI helpdesk line

Service Corridor/Cash Room Associate Nov 2007－Jan 2010 JC Penney － Mt. Juliet, TN

Assisting customers with all catalog inquiries and orders
Keeping records of out-going orders.
Completing order receipts.
Reading orders to ascertain catalog numbers, sizes, colors, and quantities of merchandise.
Obtaining merchandise from bins or shelves.
Answering and redirecting incoming telephone calls
Assisting customers with credit card concerns
In-store bookkeeping and clerical work.

Table Games Dealer Jul 2004－Oct 2007 Foxwoods Resort Casino － Ledyard, CT

Pay winnings or collect losing bets as established by the rules and procedures of a specific game.
Stand behind a gaming table and deal the appropriate number of cards to each player.
Deal cards to house hands, and compare these with players' hands to determine winners, as in black jack.
Exchange paper currency for playing chips or coin money.
Check to ensure that all players have placed bets before play begins.
Start and control games and gaming equipment, and announce winning numbers or colors.
Inspect cards and equipment to be used in games to ensure that they are in good condition.
Open and close cash floats and game tables.
Answer questions about game rules and casino policies.
Refer patrons to gaming cashiers to collect winnings.

Education