Open to opportunities

michael-anthony Spearman

@michael-anthonyspear

I am a results-driven Appeals and Grievance Specialist specializing in healthcare appeals, compliance, and process improvement.

United States

Message

What I'm looking for

I seek a healthcare appeals or grievance role where I can apply compliance expertise, streamline processes, and reduce turnaround times within a collaborative, growth-oriented team.

I am an appeals and grievance specialist with over seven years' experience managing complex healthcare cases, resolving appeals, and ensuring regulatory compliance. I have consistently accelerated processing—surpassing CMS regular timeframes by 25% and reducing case resolution time by 20%—while averaging 113 appeals per week and cutting backlog by 15%.

I am proficient with electronic health records and claims systems including Availity, Epic Systems, CareRadius, eviCore, and FACETS, and I bring strong data analysis, communication, and training skills. I seek to leverage this experience to streamline appeal workflows, mentor teams, and deliver timely, accurate determinations in a collaborative healthcare setting.

Experience

Work history, roles, and key accomplishments

Current

Content Creator

Current

The Big Fashion Guy, LLC

Mar 2012 - Present (14 years 3 months)

Curates and produces multimedia lifestyle content across digital platforms, growing audience engagement through analytics-driven strategy and securing sponsored brand partnerships.

Content Creation Video Production Social Media Management Adobe Creative Suite Analytics Brand Partnerships Written Communication

Appeals and Grievances Coordinator

Avēsis

Dec 2024 - May 2025 (5 months)

Managed the full appeals process for dental and vision services, ensuring timely, compliant resolutions and implementing policy updates to maintain regulatory adherence.

CARERADIUS Appeals Regulatory Compliance Claims Processing EHR Case Analysis CareRadius EviCore

Provider Appeals & Reconsiderations Specialist

IntegraNet Health

Oct 2022 - Jan 2024 (1 year 3 months)

Analyzed and resolved Medicare provider claims reconsiderations, processing an average of 113 appeals per week (20% above target) and reducing backlog by 15%.

Case Documentation Training Development Facets Regulatory Compliance

Appeal & Grievance Analyst

Health Alliance Plan

Nov 2017 - Oct 2022 (4 years 11 months)

Accelerated appeals processing, surpassing CMS timeframes by 25% and reducing case resolution time by 20% through thorough investigations and policy application.

Appeals Medical Record Review Regulatory Compliance Written Communication Data Analysis

Billing & Enrollment Agent

Blue Cross Blue Shield of New Jersey at Dialog Direct

Aug 2017 - Nov 2017 (3 months)

Managed billing, payments, and enrollment processes, resolving discrepancies and maintaining accurate customer records to support efficient call center operations.

Billing Enrollment Process Customer Service Database Management Call Center Operations