Christina Taylor Elzey
Dover
Summary
To obtain a position that will allow me to cultivate my intelligence to become a better asset for the company, the patients, and myself.
Overview
25
25
years of professional experience
10050
10050
years of post-secondary education
Work History
Appeals Coordinator
Medicaid Appeals Coordinator
03.2025 - Current
- Investigates and resolves member complaints and coverage denials, acting as a liaison between members, providers, and health plans to ensure fair, timely, and compliant handling of grievances and benefit appeals, involving clinical review, documentation, writing appeal letters, and navigating state/federal rules.
- They work to fix mistakes in coverage decisions, ensuring members get needed services, and their role is crucial for health plan accountability.
Utilization Management Tech
Utilization Management Tech
05.2021 - 03.2025
- Functions under the direction of the Supervisor to coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to prospective, concurrent and post service review functions.
- Interacts with facilities, vendors, providers, and other staff to facilitate receipt of information, and /or records for prompt review and response.
- Compensation plans for physicians, licensed nurse reviewers, staff, and consultants who conduct medical management do not contain incentives, directly or indirectly, that encourage barriers to care and service in making determinations.
Provider Claims Services
Provider Claims Services
Philadelphia
05.2019 - 05.2021
- Suspends claims requiring additional information and/or special handling; initiates action to obtain required information.
- Forwards claims requiring external department intervention to the appropriate department or person.
- Monitors outstanding inquiries and works with management staff to identify and resolve areas of non-compliance.
- Reviews and verifies quality audit reports.
- Reconciles audit discrepancies, corrects in system and make appropriate changes to avoid recurrence.
- Maintains thorough knowledge of claims process systems, its databases and subsystems.
- Responds to and resolves provider and health plan claim inquiries.
- Monitors and tracks aged, pended, and open reports to maintain timeliness in claims processing.
- Inputs claims into the system for appropriate tracking and processing.
- Documents file, as appropriate, to support payment decision.
- Serves as a Subject Matter Expert and conducts training as required.
- Conducts cross training to staff as required.
- Actively participates in user acceptance testing functions, such as test script development, testing and documentation of test results.
IPQ Tech
Invalid Provider Queue
Philadelphia
01.2016 - 05.2019
- Identify and maps claims to the appropriate provider number for claims in the invalid provider queue.
- Ensures that work is completed according to the service level agreement.
- Coordinates the provider mailing for all claims in the invalid provider queue that could not be processed due to missing or invalid information.
- Attends required training on an annual basis.
Enrollment Specialist
AmeriHealth Caritas State Medicaid Insurance
Philadelphia
06.2015 - 01.2016
- Monitoring all Enrollment related activities/transaction files daily, weekly, monthly to ensure timely submission/processing per regulatory guidelines.
- Identify/Research and update any issues related to the load and processing of Enrollment related data.
- Work closely with the IT department, members, providers and regulatory agencies and various vendors to troubleshoot and resolve enrollment related issues and discrepancies.
- Responsible for performing comparisons and reconciliation of membership files/records.
- Participation in projects work as needed.
- Operational research to support strategic and business planning that may impact the Eligibility and Enrollment processes.
- Any other tasks as assigned by Management.
Administrative Assistant for the Director Of Nursing
Carson Valley Behavior Health School (Temp Agency)
Flourtown
01.2015 - 06.2015
- Schedule medical and dental appointments.
- Answer all incoming calls to Nurse office, take messages.
- Confirm appointments and referrals are completed.
- Coordinate transportation for children and parents to and from appointments.
- Set up new patient/student chart, data entry into Ms Excel Spreadsheet, Ms Word Projects.
- Order all office supplies.
- Filing and other general clerical functions.
Financial Coordinator
RMA Of Philadelphia (Temp Position)
Willowgrove
08.2014 - 11.2014
- Contact patients to collect outstanding balances.
- Respond to all patients questions about their bill.
- Ensure patient fully understanding benefit information.
- Ensure proper posting of insurance payment.
- Process all mail in credit card payments.
- Verify insurance benefits for patients.
- Verify eligibility and patient demographics by using Intergy and Resource computer system.
Municipal Officer
City Of Philadelphia
Philadelphia
01.2012 - 11.2014
- An employee in this class guards a municipal building or facility on an assigned shift in accordance with building or facility safety/security rules and regulations.
- Work includes patrolling the building or facility and performing a variety of custodial duties.
- Contact with maintenance crews, law enforcement officials and the general public regarding safety of individuals and maintenance/security of the building or facility is significant to the work.
- Work is performed under the supervision of a higher level guard or an administrative superior and involves some disagreeable conditions.
Pre-cert Specialist-Call Center
Bravo Health
Philadelphia
03.2010 - 01.2012
- Accurate completing of data entry into the Health Services software systems.
- Verification of member and provider eligibility.
- Process approval and adverse determination correspondence for members, contracted and non-contracted providers with appropriate oversight.
- Clear appropriate and concise documentation of information received.
- Adherence to regulatory and departmental timeframes for review of requests received.
- Notifies member and providers of all clinical determinations.
- Activates and maintains filing and tracking systems of approval and adverse clinical determinations.
- Provides excellent customer service to internal and external providers while answering phones.
- Completes review of non authorized medical claims.
- Proficient knowledge of Health Services policies and procedures.
- Proficient knowledge of Medicare and HIPPA regulations and NCQA standards.
- Must be proficient in data entry with minimal errors.
- Professional demeanor and the ability to work effectively within a team and independently.
- Flexible with the ability to multi-task and shift priorities upon urgency.
- Attendance and Punctuality above standard.
Pre-Registration / Scheduler/Supervisor Call Center
Mercy Suburban Hospital
Norristown
03.2008 - 03.2009
- Answer incoming calls for Pre-Visit department.
- Pull referrals from Navi-net and Web MD.
- Verify Precerts and Authorization for MRI’s.
- Scheduled appointments the following departments: ct scans, MRI scans, bone scans, mammograms, ultra sound, rehab, nuclear medicine.
- Accurately scheduling the prisoners from Montgomery County Correctional facility and Graterford prison.
- Responsible for collecting co pays and deductibles from patients.
- Responsible for closing down department locking all stations.
- Relate to diverse patient and staff populations.
Financial Counselor
Children’s Hospital of Philadelphia
Philadelphia
10.2005 - 10.2007
- Transfer Guarantor accounts from IDX to Epic.
- Help with Epic Conversion of Medical Records.
- Verify insurances of patients; file and documented information in IDX for review.
- Assist families with billing and insurance questions.
- Contact patient’s guardian to verify all demographic info.
- Answer incoming calls for Pre-Visit department.
- Pull referrals from Navi-net and Web MD.
- Verify Precerts and Authorization for MRI, Airways, Child development.
Patient Service Associate- Floater
Children’s Hospital of Philadelphia
Philadelphia
01.2004 - 10.2005
- Register incoming patients.
- Check and retrieve referrals and authorizations from websites.
- Float to fill call outs for different departments.
- Validate parking for patients.
- Check and correct demographic information in the hospital system (IDX).
- Collect co-payments from families.
- Accurately batch all co-pays and make hospital deposit into PNC Bank.
Patient Service Representative/Scheduler Call Center
University of Pennsylvania
Philadelphia
07.2001 - 11.2003
- Scheduled appointments for the following departments: Scheie Eye Institute, Department of Radiology, Mammogram Department, CT Scan.
- Answered all incoming calls regarding patients.
- Called and confirmed appointments.
- Review and process correspondence with accuracy and efficiency.
- Interacted with patients and families.
Education
Non Clinical Health Management -
Southern New Hampire Univeristy
OnlineAct 235 Certification - Baton Certification, Pepper Spray Certification
Leasot Academy
Philadelphia, paMedical billing and Coding Diploma -
Prism Career Institute
Philadelphia, PaMedical Office Management Diploma -
Thompson Institute
Philadelphia, PaHigh School Diploma -
Simon Gratz High School
Philadelphia, PaSalary Requirements
50,000 - 57,000, USD, Annually
Timeline
Appeals Coordinator
Medicaid Appeals Coordinator
03.2025 - Current
Utilization Management Tech
Utilization Management Tech
05.2021 - 03.2025
Provider Claims Services
Provider Claims Services
05.2019 - 05.2021
IPQ Tech
Invalid Provider Queue
01.2016 - 05.2019
Enrollment Specialist
AmeriHealth Caritas State Medicaid Insurance
06.2015 - 01.2016
Administrative Assistant for the Director Of Nursing
Carson Valley Behavior Health School (Temp Agency)
01.2015 - 06.2015
Financial Coordinator
RMA Of Philadelphia (Temp Position)
08.2014 - 11.2014
Municipal Officer
City Of Philadelphia
01.2012 - 11.2014
Pre-cert Specialist-Call Center
Bravo Health
03.2010 - 01.2012
Pre-Registration / Scheduler/Supervisor Call Center
Mercy Suburban Hospital
03.2008 - 03.2009
Financial Counselor
Children’s Hospital of Philadelphia
10.2005 - 10.2007
Patient Service Associate- Floater
Children’s Hospital of Philadelphia
01.2004 - 10.2005
Patient Service Representative/Scheduler Call Center
University of Pennsylvania
07.2001 - 11.2003
Non Clinical Health Management -
Southern New Hampire Univeristy
Act 235 Certification - Baton Certification, Pepper Spray Certification
Leasot Academy
Medical billing and Coding Diploma -
Prism Career Institute
Medical Office Management Diploma -
Thompson Institute
High School Diploma -
Simon Gratz High School