Paris Pope
Carrollton
Summary
Detail-oriented Grievance/Appeal Analyst with strong expertise in Cotiviti claims, HCPCS coding, and effective communication. Proven ability to analyze grievances and appeals, ensuring optimal outcomes for stakeholders.
Overview
14
14
years of professional experience
Work History
Grievance/ Appeal Analyst
Elevance Health
Virginia Beach
12.2013 - 06.2025
- Analyzed and rendered determinations on assigned non-complex grievance and appeal issues.
- Serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments.
- Utilized guidelines and review tools to conduct extensive research and analyze grievance and appeal issues.
- Documented information gathered in field and uploaded data to company database for efficient processing using Nextgen.
- Prepared variety of different written communications, reports and documents
Customer Service Representative
Keystone Mercy Health Plan
Philadelphia
11.2011 - 05.2012
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Provided primary customer support to internal and external customers.
- Answered constant flow of customer calls with minimal wait times.
- Responded to customer requests for products, services and company information.
- Make data changes and perform searches for provider searches for members.
- Advised members of benefits and policies and procedures associated with their health plan.
Education
Some College (No Degree) - Health Administration
College For America
Manchester, New Hampshire Some College (No Degree) - Accounting
Clayton State University,
Morrow, Georgia Some College (No Degree) - Accounting
East Carolina University
Greenville, North CarolinaSkills
- Cotiviti claims knowledge
- Healthcare Common Procedures Coding System (HCPCS)
- Claims
- Benefits review
- Facets knowledge
- Appeals processing
- Attention to Detail
- Training and Development
- Problem-Solving
- Regulatory compliance
- Conflict resolution
- Effective communication
- Attention to detail
- Time management
- Research skills
- Verbal and written communication
- Evidence-based decision making
- Issue identification
Additional Information
Provided assistance with escalations, maintained all market cotiviti claims, provided coaching and training assistance to temp workers and new hires
References
References available upon request.
Timeline
Grievance/ Appeal Analyst
Elevance Health
12.2013 - 06.2025
Customer Service Representative
Keystone Mercy Health Plan
11.2011 - 05.2012
Some College (No Degree) - Health Administration
College For America
Some College (No Degree) - Accounting
Clayton State University,
Some College (No Degree) - Accounting
East Carolina University
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