Appeals Manager Cover Letter

I would like to submit my application for the appeals manager opening. Please accept this letter and the attached resume.

In my previous role, I was responsible for robust Annual Enrollment Period reporting - Coordinate with Medicare Finance on Annual Plans and Quarterly Forecasts.

Please consider my experience and qualifications for this position:

• Confidently and professionally engages and interacts with US Government assets specific to National Intelligence, US Military and Federal Law Enforcement and Federal Disaster Response entities
• Manages issues and critical events through their entire lifecycle owning the process and result end-to-end
• Conducts and documents detailed and comprehensive investigations into Regulatory complaints and executive requests from organizations such as the Federal Communication Committee, Public Utilities Commission, States Attorney's General offices
• Prepares concise, well written reports and analysis documents, letters and emails to a wide variety of audiences including executives, legal professionals and government regulatory bodies
• Provides feedback to, and regarding, all levels of leadership on process and human failures, technical faults, training gaps and organizational performance problems that precipitate and contribute to executive escalations
• May interact with customers prior to and or after sale to develop and maintains positive customer relations
• Experience managing business processes, including the planning, directing and coordination of operations
• Experience having direct communication with client including, but not limited to, policy development, issue analysis, strategic plan development, and presentation of statistical data

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

In the previous role, I was responsible for oversight of company health and benefits plans; coordinates between insurance providers and employees.

Please consider my experience and qualifications for this position:

• Demonstrated experience working in Human Resources or Employee/Labor Relations
• Demonstrated experience in developing, interpreting, and implementing policies, State and Federal laws, regulations, guidance, and consulting with management and employees on such policies
• Demonstrated experience presenting information verbally and in writing, which shows the application of analytical reasoning skills with appropriate supporting documentation
• Proficiency with computer word processing and spreadsheets
• Strong knowledge of Clery Act/Violence Against Women Act/Title IX
• Proficient in Medicare operations
• Knowledge of Federal Mandates and regulations (CTM, IRE-Maximus)
• Knowledge of CMS regulations as they relate to member appeals

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

In my previous role, I was responsible for a future vision of success and related requirements for ongoing improvements and to disability processes and team performance.

Please consider my qualifications and experience:

• Experience in the development of business requirements for case management system change requests and improved functionality
• Experience in analyzing and presenting data collection reporting
• Strong familiarity with health care eligibility and enrollment processes
• Experience in statutory and regulatory analysis preferred
• Knowledge of Denials Management and process flows encouraged
• Rev cycle experience
• Knowledge of laws, rules, regulations, policies, and legal practices related to health and behavioral health, and managed care
• Knowledge of claims adjudication, medical terminology, medical/hospital procedure and diagnosis coding and benefits interpretation, preferred

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

Previously, I was responsible for customer support on employee benefits questions related to health insurance, disability programs, and other benefit programs for employees of the Winchester Division.

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

• Solid experience utilizing general business principles, industry dynamics, market trends, and operations
• Working knowledge of team building and consulting/coaching techniques
• Strong communication and presentation delivery skills
• Innovative planning and problem-solving skills
• Demonstrated continual personal and professional development
• Knowledge of State and Federal discrimination, harassment, retaliation, whistleblower, and sexual misconduct laws in employment and/or education environment
• Knowledge of applicable State and Federal affirmative action plans, programs, laws and regulations
• Maintain confidential status on all unit work product

I would like to submit my application for the appeals manager opening. Please accept this letter and the attached resume.

In the previous role, I was responsible for training and direction to employers and state agencies in developing procedures to comply with grievance and appeals requirements.

Please consider my qualifications and experience:

• Knowledge of healthcare or insurance policy and/or operations
• Or completion of the Parallon Manager in Trainee Program
• Strong working knowledge of Microsoft Office (Word, Excel, Access and PowerPoint)
• Validating denial reasons following Explanation of Benefits (EOB) review
• Ensuring coding is accurate and reflects the denial reasons
• Coordinating with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary
• Generating appeals based on the dispute reason and contract terms specific to the payer, to include online reconsiderations
• Following specific payer guidelines for appeals submission