Open to opportunities

Rhonda Neven

@rhondaneven

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Dedicated Clinical Appeals Analyst with 6 years of medical claims review experience and 25+ years of

United States

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What I'm looking for

Seeking a challenging role that leverages my medical claims review experience, customer service skills, and leadership abilities to drive business growth and improve customer satisfaction.

As a seasoned Clinical Appeals Analyst, I leverage my 6 years of medical claims review experience and 25+ years of customer service experience to drive business growth and improve customer satisfaction. With a strong background in coaching and leadership, I excel in dynamic environments with multiple priorities and challenging demands.

In my current role at Blue Cross Blue Shield of North Carolina, I analyze and resolve complex appeals and grievances, ensuring timely and quality resolutions that meet company goals and regulatory requirements. My experience in medical review analysis, customer service, and team management has equipped me with the skills to excel in fast-paced environments.

I am a dedicated professional with a passion for delivering exceptional customer service and driving business results. I am confident in my ability to understand business needs and execute strategic plans to achieve company goals and markers.

Experience

Work history, roles, and key accomplishments

Current

Clinical Appeals Analyst

Current

Blue Cross Blue Shield of North Carolina

Aug 2022 - Present (2 years 9 months)

Responsible for the analysis, research, and completion of complex appeals and grievances. Ensures compliance with legislative and regulatory requirements while addressing customer concerns and ensuring timely resolutions.

Customer Service Regulatory Compliance Problem Solving Communication Research Team Collaboration Quality Assurance

Program Supervisor II

Department of Health and Human Services

Feb 2021 - Aug 2022 (1 year 6 months)

Ensured prompt delivery of vaccines to providers and superior customer service for program participants. Managed a customer services unit and coordinated vaccine ordering and accountability for over 1,200 providers.

Customer Service Program Management Compliance Communication Team Leadership Data Analysis Coordination Problem Solving

Medical Review Analyst

Blue Cross Blue Shield of North Carolina

May 2014 - Feb 2021 (6 years 9 months)

Identified and analyzed medical necessity and benefit eligibility for complex claims. Ensured compliance with regulatory requirements and communicated with members and providers regarding claims status.

Claims Regulatory Compliance Communication Data Analysis Problem Solving Documentation Team Collaboration

Charge Nurse

Hillcrest Convalescent Center

Jan 2014 - May 2014 (4 months)

Led a team of non-licensed personnel, coordinating schedules and assignments to ensure quality care delivery in a convalescent setting.

Team Leadership Patient Care Scheduling Coordination Communication Problem Solving Nursing Quality Assurance Training

Administrative/Clinical Nurse

Quantico Naval Health Clinic

Jun 2008 - Dec 2013 (5 years 6 months)

Led a team in a clinical setting, focusing on patient education, counseling, and processing referrals for continued medical care.

Patient Care Counseling Team Leadership Referrals Problem Solving Communication Nursing Coordination

Education

Degrees, certifications, and relevant coursework

University of Mount Olive

Bachelor of Science, Healthcare Management

2015 - 2019

Completed a Bachelor of Science in Healthcare Management, focusing on the principles of healthcare systems, management strategies, and patient care practices.