Appeals and Grievances
Resume:
Andria Travis
Tomball, Texas 77375
****.******@*****.***
Career Objective
As a passionate healthcare advocate, I bring extensive experience in spine care and a dedication to ensuring patients receive access to advanced medical technologies. For over a decade, I’ve worked tirelessly to support Category III codes and advocate for spine procedures like SI joint fusion, helping patients overcome coverage barriers. My ability to navigate complex healthcare processes, draft compelling prior authorizations and appeals, and resolve denials reflects my unwavering commitment to patient advocacy. I’m also well-versed in reviewing medical records for medical necessity and efficient time management. My background includes hands-on practice management knowledge, including diagnostic testing, visual acuity, and macula assessments. Professional Experience
SI-BONE, Inc. — Senior Patient Case Advocate
August 2017 – August 2024
● Championed patient advocacy by serving as the central point of contact for regional providers, patients, and the sales team, ensuring all parties had the information needed for a smooth reimbursement process.
● Proactively analyzed and thoroughly researched payor coverage policies for SI joint fusion procedures, leaving no detail overlooked to maximize the likelihood of approval.
● Worked diligently to ensure patient medical documentation was comprehensive and fully aligned with the requirements for successful pre-authorization and appeals.
● Advocated for patients, guiding them through complex reimbursement processes and addressing obstacles with persistence to secure access to life-changing SI joint fusion procedures.
● Strategically partnered with the Area Reimbursement Manager to craft and refine authorization and appeal strategies, ensuring every case was handled with precision and a results-driven approach.
● Facilitated clear and effective communication between patients, surgeons' offices, and payors, working tirelessly to secure approvals and resolve any issues during the coverage process.
● Ensured the timely submission and accurate completion of insurance forms.
● Meticulously documented case progress, maintaining detailed and organized records to support the success of future appeals and authorizations.
● Coordinated the preparation of supporting medical documentation, letters of medical necessity, and appeal letters, working closely with referring surgeons to strengthen each case.
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● Altera Med Group — Billing Agent
September 2015 – February 2017
● Filed electronic and paper medical claims for medical and vision insurance, specializing in medically necessary claims for contact lenses and eyeglasses.
● Processed claims for cataract surgeries, medical office visits, and hospital stays.
● Handled Workers Comp claims, prior authorizations, and daily charge entries.
● Resolved billing issues and reviewed claims through the clearinghouse to address payor rejections.
Today’s Vision — Office Manager
November 2010 – November 2014
● Assisted with preliminary testing for comprehensive eye exams, including testing for acuity, macula integrity, color vision, and visual fields.
● Managed contact lens orders and returns.
● Verified insurance benefits and managed medical records.
● Handled financial closings and payroll, ensuring smooth office operations. Education
● Barclay Career School — 1987-1988
SP Waltrip High School — 1982-1986
Core Professional Competencies
● Customer Service
● HIPAA Regulations
● Patient Support
● Medical Records Analysis for Medical Necessity
● Customizing Template Appeal Letters
● Insurance Verification
● Prior Authorizations
● Time Management & Organizational Skills
● Problem Solving
● Ability to Work Independently or in Teams
Software Proficiencies
● Salesforce
● OfficeMate
● Microsoft Office
● Availity
● NaviNet
**References available upon request.
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