Customer Service Representative

SUZANNE SPADONI

*** ******* ***** ** • RUSKIN, FL 33570 • PHONE 813-***-****

**********@*****.***

PROFILE

Dedicated Senior Appeal Analyst: SME/ Team lead with 20 years of experience in processing claims at all levels PROFESSIONAL EXPERIENCE

NLB/Cognizant/Cigna Healthsprings, Tampa FL

Appeal Analyst 5/2016- Current

• Processed all levels of Medicare, medical, vison and dental appeals for contracted and non-contracted providers

• Assisted with sensitive provider appeals and projects

• Directly supported nurses and doctors with clinical appeals process

• Loaded and prepared necessary appeal documentations, created decision letters and reviewed administrative appeals

• Trained employees and new hires on policy and procedures

• Provided weekly one-on-one meetings with employees Health Plans Services/Nationwide Dental, Tampa FL Claims Examiner III – 12/2011-3/2014

• Processed medical and dental claims at all levels and lead special projects

• Instructed dental processors on specific details of the claim such as which parts were payable, and which codes needed to be downgraded, accepted or denied.

• Responsible for approving appeals and grievances. Temp Agency/Wellcare Health Plans, Tampa FL

Claims Temp – 8/2009-6/2010

• Worked on a special project that researched medical over payments

• Researched and verified payment history using Microsoft Excel

• Discovered errors made to provider’s accounts and made the proper adjustments where overpayment had occurred

• Project was completed on time, under budget and was 100% successful Amerigroup, Tampa FL

Provider Service Representative – 8/2006-4/2007

● Checked statuses of accounts and explained benefits to customers

● Processed all claim types, authorizations, referrals, and appeals Oxford Health Plans, Tampa FL

Medical Claims Processor II & Customer Service Representative III – 6/1998-2/2002

● Processed medical claims for all Oxford Health Plans Providers and Members

● Served as a Customer Service Associate for members inquiring about processed claims John Barsa MD, Tampa FL

Medical Billings Supervisor – 4/1997-6/1998

● Processed medical claims, posted patient payments and collections

● Handled all appeals and calls to insurance companies

● Processed employee payroll

● Managed all appointment scheduling with the doctor Skills

• Microsoft Office (Excel, Microsoft Word, Outlook)

• Claims/Questions

• Policy/Account Changes

• Complaint / Dispute Resolution

• Self-Oriented

• Team Player and Team Lead

• Energetic Work Attitude

• Multi-Level Communication

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