Malika McGlynn
Alameda
Summary
Results-driven Appeals Specialist with strong capabilities in medical claims processing and HIPAA compliance. Proven track record in conflict resolution and effective communication with stakeholders.
Overview
14
14
years of professional experience
Work History
Appeals Specialist
Zenith American Solutions
Alameda
09.2019 - Current
- Reviewed and processed complex medical claims and appeals per plan provisions and guidelines.
- Prepared appeal cases for board of trustees review, ensuring documentation accuracy and completeness.
- Analyzed claim denials to determine appropriate resolutions regarding benefits and eligibility.
- Coordinated with providers, members, and vendors to obtain necessary records and information.
- Drafted professional correspondence, including appeal determinations and record requests.
- Utilized systems such as ISSI, SDS, and Anthem platforms to manage claims documentation.
- Investigated and resolved escalated claim issues and member concerns effectively.
- Maintained compliance with HIPAA regulations and plan policies.
Transportation Supervisor
Gate Gourmet Airline Catering
06.2017 - 09.2019
- Supervised 40+ drivers, ensuring timely completion of daily tasks.
- Coordinated flight dispatch for catering services to airlines.
- Verified issues and implemented swift problem resolution.
- Monitored satisfaction with food quality and service delivery.
- Took immediate action to address operational challenges.
- Notified management or relevant contacts when issues arose.
- Ensured compliance with safety regulations and industry standards.
- Managed schedules for delivery and pickup of catering supplies.
Security District Contact
EBMUD
Oakland
08.2012 - 04.2017
- Oversaw management of company vehicles to ensure employees had appropriate transportation for daily tasks.
- Supervised 30 employees to maintain operational efficiency and performance standards.
- Handled all security matters for EBMUD water plants throughout Bay Area.
- Maintained comprehensive paperwork required for audits and payments.
- Delivered exceptional customer service through direct interactions and phone communications.
Education
Contra Costa College
San Pablo, CA05-2026
Associate of Science - Medical Billing And Coding
Ultimate Medical Academy
Clearwater, FL09-2017
Skills
- Medical Claims & Appeals Processing
- Insurance Verification & Benefits Interpretation
- ICD-10 & Medical Terminology
- Workers’ Compensation Claims Exposure (2 years)
- Subrogation & Third-Party Liability Review
- Litigation Support & Coordination with Legal Counsel (Boehm)
- Customer Service & Conflict Resolution
- EMR Systems & Microsoft Office (Excel, Word, PowerPoint)
- Research & Investigation Skills
- HIPAA Compliance
- Administrative & Organizational Skills
Timeline
Appeals Specialist
Zenith American Solutions
09.2019 - Current
Transportation Supervisor
Gate Gourmet Airline Catering
06.2017 - 09.2019
Security District Contact
EBMUD
08.2012 - 04.2017
Contra Costa College
Associate of Science - Medical Billing And Coding
Ultimate Medical Academy