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Cgs Administrators - Dme Mac Jurisdiction C Redetermination Appeals Analyst Resume Example

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
GED Westerly High School － Westerly, RI
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Resume Details

This is a real resume for a DME MAC Jurisdiction C Redetermination Appeals Analyst in Hermitage, Tennessee with experience working for such companies as Cgs Administrators, Llc, Jc Penney. This is one of the hundreds of DME MAC Jurisdiction C Redetermination Appeals Analyst resumes available on our site for free. Use these resumes as templates to get help creating the best DME MAC Jurisdiction C Redetermination Appeals Analyst resume.

Previous Companies:

  • CGS Administrators
  • LLC
  • JC Penney

Previous Job Positions:

  • DME MAC Jurisdiction C Redetermination Appeals Analyst
  • DME MAC Jurisdiction C Tier 1 CSR
  • CEDI Helpdesk
  • Service Corridor
  • Cash Room Associate

Schools:

  • Westerly High School

Level of Education:

  • GED

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