Appeals Analyst Cover Letter

I submit this application to express my sincere interest in the appeals analyst position.

Previously, I was responsible for financial analysis, reimbursement modeling, as well as the monitoring and management of financial performance data related to managed care contracts.

Please consider my qualifications and experience:

• Proficient in Microsoft Word, Excel and Outlook- Preferred
• Knowledge of InterQual Criteria (or similar)
• Proficiency in software/applications applicable to care management
• HMO/PPO/ASO/HIX experience preferred
• Proficiency in Microsoft Office applications, including Word, Excel and Access
• Extensive knowledge of the federal and state occupational standards
• Communicating with individuals about state and federal laws, rules, and regulations
• High level of skill in doing research

Please consider me for the appeals analyst opportunity. I am including my resume that lists my qualifications and experience.

In my previous role, I was responsible for billing backup processing for complex billing, especially in allocation management across multiple departments and divisions.

My experience is an excellent fit for the list of requirements in this job:

• Knowledge of Medicare Advantage (MA) plans, Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs)
• Strong analytical, investigative and research skills and pays close attention to detail
• Strong spoken and written command of the English language demonstrated by presenting well in interview and completing a writing sample upon request
• Basic recognition of CPT, HCPCS and ICD 9/10 coding
• Proficient computer skills such as MS Outlook, Excel and Word
• Prior Appeals experience is preferred
• Experience exemplified in superior communication, interpersonal skills and project completion
• Certified Case Manager (CCM) or Legal Nurse Consultant Certified (LNCC) certification preferred

Please consider me for the appeals analyst opportunity. I am including my resume that lists my qualifications and experience.

In the previous role, I was responsible for subject matter expertise in sensor processing, phenomena, and environmental effects for multiple Geographical Information Systems (GIS).

My experience is an excellent fit for the list of requirements in this job:

• Knowledge and/or experience with applying safety and health regulations
• Experience dealing with diverse groups and conflicting views
• Requires knowledge of health care delivery systems
• Requires knowledge of community resources
• State of Florida Licensed Registered Nurse
• Demonstrated extensive experience with Medical Coverage Guidelines as it relates to medical necessity and experimental/investigational procedures
• Knowledge of HIPAA and ERISA requirements
• Knowledge of CMS regulations and guidelines related to appeals, grievances and complaints

I am excited to be applying for the position of appeals analyst. Please accept this letter and the attached resume as my interest in this position.

Previously, I was responsible for efficient and effective geospatial support services to T&S and operations including designing and implementing workflows for processing, managing and publishing geospatial information products.

Please consider my experience and qualifications for this position:

• Prior Appeals experience preferred
• Experience conducting medical reviews
• Active RN license in South Carolina
• Previous Grievances/Appeals experience preferred
• Requires keyboarding proficiency
• Prior appeals handling experience preferred
• Strong command of computer programs such as MS Outlook, MS Excel, MS Word
• Experience with Pega Database and IRE is preferred

I am excited to be applying for the position of appeals analyst. Please accept this letter and the attached resume as my interest in this position.

In the previous role, I was responsible for accurate and timely resolutions and support to operations and corporate staff relating to the delivery of worldwide insurance processing systems, workflows and processes.

Please consider my qualifications and experience:

• Experience working with BCBSF systems such as JIVA, Corporate Medical Clearance
• Application (CMCA), Diamond, Siebel
• Medicare knowledge and/or experience preferred
• Update Supervisor and Team Lead on any risks, issues or concerns identified with a case
• Track all cases currently in production
• Conduct live reviews of cases to ensure the appeal is being worked accurately
• Support Staff with addressing Process and Compliance questions related to the correct handling of an appeal
• Review all Overturn/Uphold/Dismissal recommendations prior to the final decisions