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Whitney Wright

@whitneywright

Healthcare Grievance & Appeals professional focused on CMS-compliant claims accuracy, quality audits, and continuous improvement.

United States

Message

What I'm looking for

I’m looking for a healthcare role where I can own CMS/Medicare-compliant grievance and claims accuracy, lead QA and audit work, and drive measurable quality improvements through root cause analysis and cross-functional collaboration.

I’m a results-driven healthcare professional specializing in Grievance & Appeals, claims review, and Quality Assurance in regulated environments. I investigate and resolve 80+ member grievances and appeals monthly in accordance with CMS and Medicare regulations, while maintaining 96%+ quality accuracy scores.

I strengthen outcomes through detailed case reviews, compliance auditing, root cause analysis, and trend identification to address errors and process gaps. I also prepare Maximus packets, manage high-volume workflows with turnaround-time discipline, and coordinate across internal departments to improve claims handling and documentation accuracy.

Experience

Work history, roles, and key accomplishments

Grievance & Appeals Coord.

Centene Corporation

Jan 2022 - Feb 2026 (4 years 1 month)

Investigated and resolved 80+ member grievances and appeals monthly in accordance with CMS and Medicare regulations, maintaining a 96%+ quality accuracy score. Performed case reviews and quality audits, analyzed claims documentation to determine outcomes, and prepared Maximus packets while managing high-volume workflows.

Claims Review Quality Assurance Auditing Case Investigation Trend Analysis Process Improvement

Transfer Center Coordinator

UPMC

Dec 2020 - Jan 2022 (1 year 1 month)

Coordinated patient transfers while ensuring accurate clinical and insurance-related data collection to support claims processing and reimbursement workflows. Maintained compliant documentation and facilitated physician communication to reduce delays in care coordination.

Patient Transfers Claims Processing Healthcare Compliance Clinical Documentation High Volume Data Entry

Training & Dev Lead

Allegheny Health Network

Mar 2019 - May 2020 (1 year 2 months)

Delivered in-person and remote training on workflows, compliance standards, and quality assurance practices. Conducted QA evaluations and performance monitoring, supported escalation handling with root cause analysis, and improved onboarding and operational processes through quality improvement initiatives.

Training Delivery Quality Assurance (QA)Compliance Performance Monitoring Root Cause Analysis Quality Improvement Onboarding Escalations

Clerk Typist II

Allegheny County Health Department

Jun 2016 - Mar 2019 (2 years 9 months)

Managed complaint intake and documentation with a focus on accuracy, compliance, and timeliness. Contributed to a quality improvement project to streamline workflows and improve response times while maintaining organized records aligned with regulatory and reporting standards.

Quality Improvement & Regulatory Case Investigation Support Timeliness & TAT Compliance Reporting Record Management

Call Center Executive Asst

PA Cyber

Aug 2010 - Jul 2015 (4 years 11 months)

Provided executive and administrative support including calendar management, scheduling, and cross-department priority coordination. Handled high-volume confidential communications, tracked and escalated technical and operational issues, and improved efficiency through organized systems for data tracking and reporting.

Executive Administrative Support Calendar Management Confidentiality Issue Tracking Data Tracking Process Improvement Meeting Coordination