Joanna Murchison

Investigate and resolve member health insurance complaints and disputes, analyze claims, ensuring full compliance with CMS (Centers for Medicare & Medicaid Services) regulations. Document findings and draft formal written responses to uphold organizational policies and improve member satisfaction. Identify trends and escalate complex cases for clinical review to ensure due process and quality of care.

Appeals and Grievance Representative at iCare Health Solution/VSP (2022-08 – Present)

• Investigate and resolve member health insurance complaints and disputes, analyze claims, ensuring full compliance with CMS (Centers for Medicare & Medicaid Services) regulations.
• Document findings and draft formal written responses to uphold organizational policies and improve member satisfaction.
• Identify trends and escalate complex cases for clinical review to ensure due process and quality of care.
• Prioritize expedited cases and high-priority concerns, maintaining strict adherence to regulatory and internal deadlines.

Appeals and Grievance Representative at AmeriHealth Caritas (2020-04 – 2022-01)

• Case Management: Conduct end-to-end case intake, thorough investigation, and detailed documentation for all appeals and grievances
• Regulatory Compliance: Ensure all resolutions are accurate, timely, and consistent with federal, state, and accreditation standards.
• Stakeholder Liaison: Serve as a primary point of contact between members, healthcare providers, and internal departments to facilitate effective issue resolution.

Caregiver at Papa Pal (2019-08)

Independent Contractor

• Non-Medical Support: You provide social interaction, help with hobbies (like games or gardening), and emotional support.
• Daily Management: Assistance includes running errands, grocery shopping, providing transportation to appointments, light housekeeping (laundry/dishes), and meal preparation.

Medical Insurance Billing and Coding Certificate (2008-01 – 2008-01)

High School Diploma (2009-06 – 2009-06)

Health Service Administration (AA) Degree in Health Service Administration (2015-06 – 2015-06)