Iliana Carrillo

• Effectively identifies root cause of complex issues acting as a member advocate in various cases.

• Assists in the development of process improvement functions.

• Assures timeliness and appropriateness of appeals according to state and federal guidelines.

• Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.

• Determines appropriate language for letters and prepares responses to appeals and grievances while

generating denial letters.

• Enters denials and requests information into systems and prepares documentation for further review.

• Addresses and resolves a wide variety of basic to complex member, provider and other issues.

• Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.

• Creates and maintains statistics and reporting for various teams and departments.

• Works with provider & member services to resolve balance bill issues and other member/provider complaints.

• Demonstrated ability to manage multiple projects and remain flexible.

• Effectively identifies root cause of complex issues acting as a member advocate in various cases.

• Assists in the development of process improvement functions.

• Assures timeliness and appropriateness of appeals according to state and federal guidelines.

• Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research.

• Determines appropriate language for letters and prepares responses to appeals and grievances while

generating denial letters.

• Enters denials and requests information into systems and prepares documentation for further review.

• Addresses and resolves a wide variety of basic to complex member, provider and other issues.

• Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner.

• Creates and maintains statistics and reporting for various teams and departments.

• Works with provider & member services to resolve balance bill issues and other member/provider complaints.

• Demonstrated ability to manage multiple projects and remain flexible.

high school education