Krystal Feggins Blount
Florence
Summary
Results-driven Appeals Specialist with expertise in appeal evaluation, medical record analysis, and claims processing. Proven ability to ensure regulatory compliance and improve documentation accuracy, contributing to efficient resolution of complex cases.
Overview
11
11
years of professional experience
Work History
Appeals Specialist
PalmettoGBA
Florence
01.2018 - Current
- Evaluated appeal processes and recommended improvements for efficiency.
- Analyzed medical records to determine if further information was needed in order to process appeals.
- Coordinated with internal departments to ensure timely resolution of appeals.
- Demonstrated ability to work independently as well as collaboratively within a team environment.
- Researched complex cases involving multiple parties or multiple issues to provide accurate decisions on appeals.
- Participated in training sessions on new rules or regulations affecting the appeals process.
- Maintained up-to-date knowledge of applicable laws, regulations, policies and procedures related to appeals processing.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Checked documentation for appropriate coding, catching errors and making revisions.
- Collaborated with fellow team members to manage large volume of claims.
- Examined claims, records and procedures to grant approval of coverage.
Claims Specialist
Blue Cross Blue Shield
Florence
06.2015 - 01.2018
- Evaluated claims for accuracy and compliance with company policies.
- Reviewed medical documentation to ensure appropriate coverage decisions.
- Communicated effectively with members regarding benefits and claims status.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Collaborated with other departments within the organization to resolve issues related to claims processing.
Education
High School Diploma -
Bennettsville High School
Bennettsville, SC06-1988
Some College (No Degree) - Licensed Practical Nurse
Florence-Darlington Technical College
Florence, South Carolina, SCSkills
- Appeal evaluation
- Medical record analysis
- Claims processing
- Regulatory compliance
- Documentation review
- Insurance verification
References
References available upon request.
Timeline
Appeals Specialist
PalmettoGBA
01.2018 - Current
Claims Specialist
Blue Cross Blue Shield
06.2015 - 01.2018
High School Diploma -
Bennettsville High School
Some College (No Degree) - Licensed Practical Nurse
Florence-Darlington Technical College