Chona P. Nunez

***** ********* ******, *******, ** 48221 248-***-**** ad23lb@r.postjobfree.com

Professional Summary

Results-oriented, experienced of 10 years skillful in managing and breaking down large volumes of information. Proactive at heading off issues in operations, workflow and production by uncovering trends affecting business success. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Interact effectively, excellent communication skills, perform independently and meet deadlines in a timely manner.

Work History

Resolving Analyst, 01/2022 - 07/2023 UnitedHealth Group – Remote/telecommuter

Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization. Investigate, recover, and resolve all types of claims as well as recovery and resolution for all health plans ( Medicare, Veterans, government entities, contractual agreements statewide etc.) Investigate and pursue recoveries and payables on subrogation claims and file management. Send determination letters to pertaining parties including correct COC language per the contractual agreement and internal policies.

Appeals and Grievances Coordinator, 10/2015 - 12/2022 UnitedHealth Group – Remote/telecommuter

Provide expertise or prior authorization support by reviewing, investigating, resolving all types of members, provider, third party vendor concerns pertinent to appeals and grievances with Physicians and Pharmacy daily. Collaborate with medical professionals to resolve insurance claims for Medicare/Retirement, government entities, contractual agreements, Fraud and Abuse etc. Examine claims, records and procedures to grant approval for coverage or prior authorization. Maintain confidential records on patient treatments and diagnosis to alleviate possible data breaches. Resolve verbal and written claims, medical pre/post-service, Part D, urgent, legal representatives from both providers and members. Gathering supporting documentation for case review. Create response letters adhering to COC language when delivering outcome or determination to all pertinent parties in a timely manner in accordance with State and Federal guidelines and compliance.

Billing Specialist, 11/2014 - 02/2015 Decton Inc. Staffing – Anaheim, CA

Researched and resolved billing discrepancies to enable accurate billing. Assisted with billing inquiries and provided timely responses to enhance customer satisfaction. Monitored customer accounts to identify and rectify billing issues. Provided excellent customer service, developing and maintaining client relationships.

Legal Assistant, 01/2014 - 10/2014 Lanzone Morgan LLP – Long Beach, CA

Organized documents to manage paper and electronic filing systems of clients. Filed court documents and legal pleadings with court clerk on behalf of attorneys. Prepared and drafted correspondence and legal forms to maintain smooth communications. Managed accounts and client records of clients, observing confidentiality, and extreme discretion.

Store Manager, 09/2011 - 01/2014 Nature Nook Floral Center – Detroit, MI

Managed inventory control, cash control, and store opening and closing procedures. Managed store employees successfully in a fast-paced environment through proactive communication and positive feedback. Completed point of sale opening and closing procedures. Rotated merchandise and displays to feature new products and promotions.

Project Coordinator, 07/2011 - 09/2011 BlueCross BlueShield Of Michigan – Detroit, MI

Kept projects on schedule for the GlidePath program at the testing phase by managing deadlines and adjusting workflows. Administrative support/project management from start to finish liaised between departments to facilitate communication and keep appropriate parties updated on project developments. Managed competing demands and professionally adapted to frequent change, delays and unexpected events.

Document Specialist/Legal Assistant, 09/2008 - 12/2010 Hall Render Killian Health & Lyman – Troy, MI

Maintained organized and efficient document flows by using excellent planning and multitasking skills. Prepared digital files, physical documents and work requests in compliance with company guidelines. Managed file archival and information retrievals. Transmitted documents, organized revisions and tracked changes.

Education

No Degree: Accounting, 01/1984

University of Liberia - Monrovia, Liberia

Skills

Word, Excel, Access, PowerPoint, Outlook, AS400, Reflections, RX claims, SharePoint, CMS, Polaris, PAD, ICUE, Fraud & Abuse, Pharmacy claims, CL Letter

References: Available upon request