Anasia Robinson
Willow Springs
Summary
Skilled team player with strong background in Health Insurance and Customer Service. Works well independently or as a team to handle assignments and always ready to go beyond basics assignments. Quick learner with good computer abilities.
Overview
13
13
years of professional experience
Work History
APPEALS COORDINATOR
Amerihealth Caritas
Pennsylvania, PA
03.2023 - Current
- Research and Investigate member and/or provider appeals and grievance requests, Outreach calls made to members/participants, providers and/or member/participant representatives to acknowledge receipt of appeal/grievance and discuss intent of appeal/grievance, Explain the appeal/grievance process including helping members understand the outcome and implication of appeals decisions, Prepares case file (original denial, all information received on appeal, medical records, etc.), Schedule participant/member for committee panel, sends scheduling letter, Prepare and send cases files to other teams as needed, ensure that all problems with appeals/grievances presented by plan members/participants are resolved in accordance with established policies and procedures, Maintains quality and compliance standards as dictated by the state and federal entities, Monitors caseload daily to ensure all cases are kept within compliance; follows up and escalates when compliance standards are at risk, Ensure case file is sent to appropriate committee for decision, Creates decision letter with detail description of the nature of appeal / grievance including rational for the decision and options for moving forward
HOME HEALTH CARE AIDE
Aegis
Chapel Hill, NC
12.2022 - Current
- Assist patients with various activities of daily living, including using the toilet, bathing, dressing, preparing food, eating, drinking, and moving around; Follow patient care plan directives as recommended or instructed by nurse; Perform regular homemaking chores, such as doing dishes, sweeping and mopping floors, doing laundry, and cleaning patient medical equipment; Ensure safe, healthy, clean, and uplifting patient environment at home
APPEALS COORDINATOR
Blue Cross Blue shield Medicare (Contract)
Durham, NC
04.2022 - 12.2022
- Acknowledged all expedited and part D cases before they are sent to an analyst; Checked members folder for duplicates; Informed the analyst via email when expedited or standard part D cases are sent to their queue; Attached and routed Maximus correspondence; Run and distribute daily, weekly and monthly reports within the department; Identified complaints and routed appeals and grievances to analyst; Used problem-solving skills to properly handle incoming mail and complaints; Attached and routed incoming faxes or mail to analyst or appropriate departments; Routed cases for review to the ERC; Checked voicemails
ADMINISTRATIVE ASSOCIATE II
Health and Human Services Medicaid
Durham, NC
03.2021 - 03.2022
- Answered inbound calls related to Health insurance coverage; Answered a multi-line phone system; Assisted with Primary care provider changes; Answered questions related to prior authorizations and claims; Explained benefits and eligibility ; Directed to appropriate departments for additional help
RIEMBURSMENT SPECIALIST
Trial card
Morrisville, NC
08.2020 - 02.2021
- Gathered patient, provider and prescription drug information for the payer; Called payer to obtain benefits and eligibility; Documented calls; Prepared verification of benefits for provider
APPOINTMENT SCHEDULING
Firstsource Healthcare
Morrisville, NC
04.2018 - 08.2020
- Made outbound calls to health plan members on behalf of their insurance provider to schedule in home health or teleheath visits; Accurately and concisely documented customer feedback and special needs indicated during each call in a computer based system; Identified and addressed member issues and anticipates future needs by providing additional information as needed; Navigated in a window based system to access the appropriate information to service the customer; Operated various office equipment including telephone and computer.
CUSTOMER CARE SPECIALIST
Humana Insurance Company
Cary, NC
06.2016 - 03.2018
- Handled incoming calls from Medicare members to assist with claims, benefits, billing, pharmacy and unresolved grievances and appeals; Utilized system of Customer Relationship Managment to view claims status, authorizations and referrals and create log of interactions with customers; Documented customer inquiries by using established best practices; Complied with all HIPPA and CMS regulations; Educated customers about our products and services over the phone; Scheduled medical appointments and transportation for patients and/or care givers when needed.
CASHIER
Wal-Mart
Chapel Hill, NC
07.2015 - 06.2016
- Applied discounts; processed payments and ringing up sales on computerized cash register; Answered questions about merchandise store policies and ongoing promotions.
CASHIER
Harris Teeter
Chapel Hill, NC
07.2013 - 07.2015
- Bagged and scanned groceries; applied discounts and coupons; processed payments; provided carryout and parcel pickup services; loaded merchandise into customer vehicles.
Education
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Northwood High School
Pittsboro, NCSkills
- Microsoft XP, Word, Excel, and PowerPoint
- CRM software from Salesforce
- Litton Info-crossing software for CMS (Centers for Medicare & Medicaid services)
- Speaking/Communication
- NC Tracks
- NC Fast
- CPT coding
- Claims
- Authorizations
- Managed Care
- Inbound & Outbound calls
- Friendly and pleasant manner
- Data entry
- Typing and word processing
- Documentation
- Active listening
- Paying Attention to detail
- Problem solving
- Analytical Thinking
- Researching
- Appeals & Grievances
- Naviealth
- Medical Terminology
- Activities of Daily Living (ADL)
- Organizational Skills
- Interpersonal Skills
Timeline
APPEALS COORDINATOR
Amerihealth Caritas
03.2023 - Current
HOME HEALTH CARE AIDE
Aegis
12.2022 - Current
APPEALS COORDINATOR
Blue Cross Blue shield Medicare (Contract)
04.2022 - 12.2022
ADMINISTRATIVE ASSOCIATE II
Health and Human Services Medicaid
03.2021 - 03.2022
RIEMBURSMENT SPECIALIST
Trial card
08.2020 - 02.2021
APPOINTMENT SCHEDULING
Firstsource Healthcare
04.2018 - 08.2020
CUSTOMER CARE SPECIALIST
Humana Insurance Company
06.2016 - 03.2018
CASHIER
Wal-Mart
07.2015 - 06.2016
CASHIER
Harris Teeter
07.2013 - 07.2015
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Northwood High School