William Davis Email & Phone Number

United States

Kansas City, Missouri, United States

Serves as a non-clinical subject matter expert for complaints, grievances, and appeals functions by investigating and identifying member, provider, and/or claim processing appeals and customer service grievances issues. Ensures investigation resolution and responses are processed promptly in accordance with Federal and State regulatory requirements guidelines and CMS requirements/guidelines. Evaluate and analyze claims involved in Grievances and Appeals Identify and report quality of care issue. Independently re-evaluate medical claims and associated records by applying advanced knowledge of all relevant and applicable Federal and State regulatory requirements/guidelines, EOC's (Evidence of Coverage), and knowledge of Blue Cross Blue Shield policies and procedures Develop and document timely accurate responses to complaints, grievances, and appeals utilizing Federal, State, CMS and Blue Cross and Blue Shield Association requirements. Perform timely follow-up actions to the claims department for adjustment for overturned decisions and perform quality checks to ensure accuracy. Collect and analyze supporting documentation involving claims and make appropriate decisions involving grievances and appeal determinations/resolutions.

Lees Summit, Missouri, United States

Train new hires. Assist members and providers with calls. Work special projects for the department. Problem solve issues that arise from calls.

Trained and mentorerd new hires. Assist brokers and customers with calls. Worked on special projects for the department. Retreived out of date trades from internal archives.

Bachelor Of Business Administration (Bba)

Bachelor Of Business Administration - Bba, Business Administration And Management, General, 3.5 Gpa