The role of an Appeals Coordinator is to investigate on the complaints received from the Patient’s end and solve it satisfactorily. Summary of duties listed on the Appeals Coordinator Resume include – responding to complaints immediately, evaluating eligibility criteria of suitable cases, conducting investigation for detecting negligence on part of the hospital team, advising legal actions, taking suitable action against offending staff, listening to the grievances, preparing information report, detecting the truth of the lodged complaint, and arranging for compensation if the patient’s complaint is true.
To become as Appeals Coordinator, possessing these skills would prove to be resourceful – a comprehensive knowledge and awareness of healthcare service and medical terminologies, familiarity with CPT/ HCPC and ICD9 coding; ethical behavior, the discrepancy to maintain confidentiality and the ability to work as per medical rules guidelines. A Bachelor’s degree in Business or Hospital Management is commonly seen on most of the resumes.
Summary : Results-oriented Appeals Coordinator with a decade of experience in healthcare compliance and claims management. Proven expertise in analyzing and resolving complex appeals, ensuring adherence to regulatory requirements. Strong communicator with a track record of improving recovery rates and streamlining processes. Eager to leverage skills to enhance operational efficiency and patient satisfaction.
Skills : Case Management, Legal Research, Documentation Skills, Communication Skills
Description :
Supervised the Denial Management follow-up unit, ensuring timely resolution of appeals.
Monitored monthly collections and follow-up on all appeals filed by staff, enhancing recovery rates.
Developed and implemented an effective inpatient follow-up process to streamline operations.
Trained new follow-up staff to maintain consistency and accuracy across the department.
Strategized follow-up activities to maximize collections and improve patient outcomes.
Created standardized reports to track overturn rates and collection progress.
Identified database issues and recommended process improvements to meet client needs.
Experience
10+ Years
Level
Senior
Education
B.S. in HA
Sr. Appeals Coordinator Resume
Headline : Dynamic Appeals Coordinator with 7 years of comprehensive experience in managing and resolving appeals within the healthcare sector. Demonstrates strong analytical skills and a deep understanding of regulatory compliance. Proven ability to enhance operational procedures and improve patient outcomes through effective communication and teamwork.
Investigate and coordinate grievances and appeals, ensuring compliance with regulatory standards.
Maintain accurate databases for appeal tracking and reporting required by governing agencies.
Analyze Medicare claims and customer histories to identify resolution pathways.
Draft formal correspondence for redetermination requests and other appeals.
Utilize tracking systems for trend analysis and reporting.
Stay updated on Medicare policy changes and departmental guidelines.
Review and reprocess Medicare B claims, ensuring billing accuracy through knowledge of ICD9, CPT, and HCPCS codes.
Experience
5-7 Years
Level
Executive
Education
B.S. in HA
Jr. Appeals Coordinator Resume
Summary : With a solid decade of experience in appeals coordination, I excel in resolving complex healthcare cases while ensuring compliance with regulatory standards. My analytical skills and effective communication have led to significant improvements in claims recovery rates and operational workflows, ultimately enhancing patient care and satisfaction.
Ensured compliance with CMS regulations while processing pre and post-service appeals for Medicare members.
Evaluated member eligibility for appeals, maintaining accurate records and documentation.
Collaborated closely with healthcare professionals to facilitate medical DME appeals.
Coordinated with medical facilities to obtain necessary records and documentation for case analysis.
Produced and dispatched Maximus packets detailing case determinations to relevant stakeholders.
Adjudicated claims, ensuring accurate data entry and timely processing.
Led efforts to enhance communication between departments to streamline the appeals process.
Experience
7-10 Years
Level
Management
Education
B.S. in HA
Lead Appeals Coordinator Resume
Summary : Accomplished Appeals Coordinator with 10 years in healthcare claims resolution and compliance. Skilled in navigating complex appeal processes, ensuring alignment with regulatory standards. Proven ability to enhance recovery rates and optimize operational workflows, delivering exceptional service and patient satisfaction.
Skills : Research Skills, Negotiation Skills, Organizational Skills, Multitasking, Empathy
Description :
Oversaw the complete process of appealing and contesting parking citations, ensuring thorough documentation and compliance.
Effectively managed high-stress interactions with customers, resolving disputes through active listening and negotiation.
Analyzed citation data to identify patterns, leading to policy recommendations that reduced citation issuance.
Processed and entered up to 50 appeals daily into the Flex parking program, ensuring accuracy and timely follow-up.
Conducted research and evaluation of up to 35 appeals daily to determine eligibility and compliance.
Responded to extensive email inquiries from customers and organizational staff, maintaining a high level of professionalism.
Provided strategic recommendations to senior management to enhance appeal processes and operational efficiency.
Experience
7-10 Years
Level
Management
Education
B.S. Health Admin.
Appeals Coordinator III Resume
Objective : Accomplished Appeals Coordinator with 5 years of extensive experience in managing healthcare appeals and ensuring compliance with regulatory standards. Adept at analyzing complex claims and implementing effective resolution strategies. Proven track record of enhancing recovery rates and streamlining appeal processes to improve patient outcomes and operational efficiency.
Skills : Microsoft Office Suite, Project Management, Attention To Detail, Analytical Thinking, Emotional Intelligence
Description :
Follow-up and coordinate all clinical denials to ensure timely resolution.
Maintain a comprehensive denial database to track trends and identify improvement opportunities.
Collaborate with external partners to communicate denial appeal status and determine payment outcomes.
Develop denial prevention strategies based on data analysis and trends.
Work with the utilization review team to complete Illinois Medicaid Certifications promptly.
Track all Illinois Medicaid ICD-10 certification codes to ensure accurate coding for payment.
Act as a liaison for multiple external organizations to facilitate communication and resolution.
Experience
2-5 Years
Level
Junior
Education
B.S. Health Admin.
Appeals Coordinator II Resume
Summary : Seasoned Appeals Coordinator with 10 years of specialized experience in healthcare appeals management and regulatory compliance. Expertise in analyzing complex claims and implementing effective resolution strategies to improve operational efficiency. Committed to fostering clear communication among stakeholders, leading to enhanced recovery rates and patient satisfaction.
Review, research, and investigate inquiries and appeals, providing timely resolutions to members and providers in compliance with federal regulations.
Utilize analytical skills to assess complaints, identifying key issues and implementing effective resolutions.
Ensure completion of responses within established timeframes while maintaining high-quality standards.
Assist team members with routing and handling of appeals, fostering a collaborative environment.
Support supervisors with administrative tasks, stepping in as team leader in their absence.
Prepare correspondence to address provider and member issues, ensuring clarity and compliance.
Coordinate with billing departments to secure necessary inpatient authorization numbers.
Experience
10+ Years
Level
Senior
Education
B.S. Health Admin
Appeals Coordinator Resume
Summary : Strategic Appeals Coordinator with 10 years of experience in healthcare claims management and regulatory compliance. Skilled in navigating complex appeal processes and improving recovery outcomes through effective negotiation and communication. Committed to enhancing operational efficiency and patient satisfaction by implementing streamlined workflows and fostering interdepartmental collaboration.
Skills : Time Management, Legal Terminology, Filing Systems, Customer Service, Data Entry
Description :
Verify participant eligibility based on plan documents and rules for appeals preparation.
Engage with healthcare providers, participants, and insurance companies via phone, fax, or email to gather essential information for appeals.
Managed the appeals process for denied claims, ensuring timely resolution and compliance with regulations.
Maintain accurate and organized records for all files related to appeals.
Draft and compose appeals, preparing comprehensive files for submission to Trustees.
Reviewed and analyzed appeal requests to determine validity and necessary documentation for submission.
Track daily appeals activity and provide updates to Customer Service personnel.
Experience
10+ Years
Level
Senior
Education
B.S. in HCA
Appeals Coordinator I Resume
Summary : Dedicated Appeals Coordinator with 10 years of experience in navigating complex healthcare appeal processes and ensuring regulatory compliance. Recognized for enhancing operational efficiency and improving recovery outcomes through meticulous analysis and effective communication. Committed to fostering collaboration among stakeholders to drive patient satisfaction and optimize service delivery.
Evaluate incoming correspondence to determine appropriate actions for grievances.
Initiate comprehensive case file processes for all appeals.
Conduct thorough research on complaints, ensuring compliance with regulatory standards.
Draft grievance decision letters with accurate and required content.
Adhere to timelines for correspondence decision letters, ensuring prompt communication.
Assess and optimize the appeal process, implementing necessary changes.
Maintain databases for reporting purposes, ensuring data integrity.
Experience
7-10 Years
Level
Management
Education
BSHM
Appeals Coordinator/Executive Resume
Summary : Highly experienced Appeals Coordinator with a decade of expertise in managing complex healthcare appeals and ensuring compliance with regulatory standards. Proficient in analyzing claims, enhancing operational procedures, and improving recovery rates. Passionate about optimizing processes to ensure exceptional service delivery and patient satisfaction.
Skills : Claims Analysis, Regulatory Knowledge, Workflow Optimization, Policy Interpretation, Training And Development
Description :
Developed and implemented strategies to improve the appeals process and reduce denial rates.
Served as a liaison between clients and insurance providers to resolve outstanding appeals.
Guided appellants in obtaining health insurance through Marketplace.
Coordinated information collection and presentation for appeals.
Documented phone conversations in a computerized database for follow-up actions.
Researched member information to address complex inquiries effectively.
Scheduled follow-up calls and appointments to ensure timely resolutions.
Experience
7-10 Years
Level
Management
Education
BSHA
Appeals Coordinator/Analyst Resume
Headline : Accomplished Appeals Coordinator with 7 years of expertise in managing healthcare appeals and ensuring compliance with industry regulations. Skilled in analyzing complex claims and developing effective resolution strategies that enhance operational workflows. Committed to improving recovery rates and fostering collaboration among stakeholders to elevate patient satisfaction and service quality.
Prepare incoming appeal cases for review by clinical staff and the Center for Health Dispute Resolution.
Request and compile accurate information in compliance with departmental guidelines.
Complete case preparations efficiently to ensure timely closure within departmental timeframes.
Create and send thorough member correspondence that aligns with departmental standards.
Identify cases meeting business decision payment criteria.
Adhere to company performance standards to maintain operational excellence.
Collaborate with cross-functional teams to enhance the appeal process and improve outcomes.
Experience
5-7 Years
Level
Executive
Education
B.S. in HCA
Appeals Coordinator/Representative Resume
Objective : Passionate Appeals Coordinator with 5 years of experience in managing and resolving healthcare appeals. Proven ability to analyze complex cases, ensuring compliance with regulatory standards. Committed to enhancing operational efficiency and patient outcomes through effective communication and collaboration with stakeholders.
Skills : Team Collaboration, Document Review, Report Writing, Problem Solving, Technical Proficiency
Description :
Managed the complete appeals process, including reviewing, researching, and triaging diverse appeals and grievances.
Communicated effectively with stakeholders regarding appeals and grievance issues, ensuring clear understanding and resolution.
Accurately categorized complaints and ensured compliance with regulatory standards.
Verified member eligibility and benefits to facilitate accurate appeal decisions.
Gathered additional documentation necessary for thorough case review, enhancing decision accuracy.
Maintained organized documentation in the image repository for easy access and retrieval.
Initiated proactive outreach to members and providers, fostering strong relationships and improving communication.
Experience
2-5 Years
Level
Junior
Education
B.S. Health Admin.
Appeals Coordinator Resume
Objective : Bringing 5 years of specialized experience as an Appeals Coordinator, I excel in managing healthcare appeals and ensuring compliance with industry regulations. My analytical abilities drive effective resolution strategies, enhancing recovery rates. I am dedicated to fostering collaboration among team members and stakeholders to optimize processes for improved patient outcomes and satisfaction.
Creating an account is free and takes five seconds.
You'll get access to the PDF version of this resume template.
Choose an option.
Sign up with Google
Sign up with Facebook
Sign up with Linkedin
This helps us make sure you're human and prevents spammers from abusing our services.
By continuing, you agree to our Privacy Policy and Terms.
Unlock the Power of Over 10,000 Resume Samples.
Take your job search to the next level with our extensive collection of 10,000+ resume samples. Find inspiration for your own resume and gain a competitive edge in your job search.
Get Hired Faster with Resume Assistant.
Make your resume shine with our Resume Assistant. You'll receive a real-time score as you edit, helping you to optimize your skills, experience, and achievements for the role you want.
Get Noticed with Resume Templates that Beat the ATS.
Get past the resume screeners with ease using our optimized templates. Our professional designs are tailored to beat the ATS and help you land your dream job.
