ANYA SCHADOWSKY

San Antonio, TX *****

ady25h@r.postjobfree.com

+1-806-***-****

Knowledgeable and dedicated customer service professional with extensive knowledge in appeals and grievances industry. Solid team player with outgoing, positive demeanor and proven skills in established rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results oriented with exemplary passion for developing relationships, cultivating partnerships and growing business.

Work Experience

Appeals and Grievances Specialist

Baylor Scott and White Health - Remote

August 2022 to Present

Resolve and prepares written response to incoming provider reconsideration requests relating to claims payment and requests for claim adjustments or to requests from outside agencies. Research claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. Identify potential provider problems through a proactive approach in which data is mined and trended to identify and prevent provider problem areas. Use a variety of references to research and prepare health-care provider information for loading into the health plan system/ database; enters provider demographics, contract affiliation, or other data as needed. Interface with other departments regarding questions about provider configuration or other relevant provider issues. Compose all correspondence and appeal information concisely and accurately, in accordance with regulatory requirements. Maintain tracking system of correspondence and outcomes; maintains well- organized, accurate and complete files for all appeals. Monitor each request to ensure all internal and regulatory timeliness are met

Specialty Prior Authorization Department

CVS Caremark - WFH - San Antonio, TX

April 2016 to August 2022

Implemented and change managed multiple new process improvement projects for the appeals staff successfully. Facilitated training on general knowledge of the scheduling tool and the WFM department. Willingness to take initiative for learning, increasing knowledge and improving skills in a self-directed manner to improve performance and position added value. Independently assess, investigates and resolves difficult issues to achieve appellant satisfaction by utilizing company and industry knowledge of operational areas and all established policies and procedures. Track appeals in the access data base to ensure specific turnaround time for responses and provide data for state required or requested reports. Gather, compile and Produces monthly/quarterly reports on appeals process for carriers and management including, but not limited to, number of appeals by categories, number of denials upheld and adjusted and time-frames met. Provide feedback to service teams and management in an effort to educate and reduce overall appeal volume

Expert Trainer

Applebee's - San Antonio, TX

January 2014 to December 2016

Consistently provided friendly guest service and heartfelt hospitality.

• Promptly and empathetically handled guest concerns and complaints.

• Demonstrated integrity and honesty while interacting with guests, team members and managers.

• Greeted customers and provided excellent customer service.

• Pleasantly and courteously interacted with customers.

• Maintained high standards of customer service during high-volume, fast-paced operations.

• Built loyal clientele through friendly interactions and consistent appreciation.

• Cross-trained and coordinated scheduling with team members to ensure seamless service.

• Prepared fountain drinks and ice cream items.

• Assembled food orders while maintaining appropriate portion control.

• Verified that prepared food met all standards for quality and quantity.

• Handled currency and credit transactions quickly and accurately.

• Followed food safety procedures according to company policies and health and sanitation regulations. Prepared quality products while maintaining proper food safety practices, portion control and presentation within service goal times.

• Strictly followed all cash, security, inventory and labor policies and procedures.

• Stored food in designated containers and storage areas to prevent spoilage or cross- contamination. Maintained clean and safe environment, including in the kitchen, bathrooms, building exterior, parking lot, dumpster and sidewalk.

• Reported to all shifts wearing a neat, clean and unwrinkled uniform.

• Reported to each shift on time and ready to work.

• Performed all position responsibilities accurately and in a timely manner.

• Communicated openly and honestly with the management team during each shift to ensure it ran smoothly. Immediately informed supervisors when supplies were low or if equipment was not functioning properly. Prepped items for later use to save staff time during busy hours. Education

Bachelor of Science in Health Information Management Purdue University Global - San Antonio, TX

June 2023 to Present

Skills

• Preparation of appeals Documenting research Information verification Work organization and prioritizing Customer service Problem solving Insurance claims forms review Verbal and written communication Teamwork and collaborate Attention to detail Payment and investigation escalation Regulatory compliance Adherence HIPAA Insurance terminology Benefit verification (6 years)

• Process Improvement

• Pharmacy Technician Experience

• Quality Assurance

• Research

• Technical Support

Contact this candidate