Deborah Kessler Email & Phone Number

Comprehensive knowledge of the insurance and health care industries as it relates to Quality Improvement Organizations (QIO), and the Centers for Medicare & Medicaid Services (CMS), Medicare Parts A-D, as it pertains to Beneficiaries, healthcare facilities, and health plans. Extensive Medicare experience with a focus on investigating and resolving high-volume and sensitive disputes, while managing daily confidential customer service operations. Possess a strong understanding of the CMS Medicare laws, guidelines, and processes. Responsibilities for the QIO and Medicare claims included customer call backs and creating written correspondence while resolving Medicare appeals and complaints for Medicare beneficiaries and their families/caregivers, and handling advocacy issues. This process included intake from the beneficiary (complaint/appeal), requesting medical records, required Medicare forms, research and validation, and compliance of the CMS Medicare guidelines. The complaint/appeals follow up involved physicians and pharmacists, family members, health plans, nursing homes, and hospitals. Effective communicator, with an excellent understanding and ability to work with a cross function team to meet and exceed turnaround time for high volume recipients, coupled with quality outcomes.

Listed skills include Outlook, Crmis, Access, Simsol, and 25 others.

• 

  Southwestern Medical Academy

  Cms / Cna