At Centene Corporation, I manage approximately 140 Medicare and Medicaid member cases each month, reviewing clinical documentation, coordinating resolutions, and maintaining a 100% quality audit score.
Previously at Highmark Blue Cross Blue Shield, I investigated claim denials, reimbursement disputes, and payment discrepancies using medical records, billing documentation, policy provisions, and coverage guidelines. I also trained new hires on claims systems, policy interpretation, and investigation procedures.
My healthcare operations background includes patient liaison work at General Physician, P.C., where I coordinated cardiac care and helped patients navigate barriers to treatment. I bring detailed documentation, regulatory compliance, case management, and cross-functional collaboration to complex member and provider concerns.
