Amanda Sotelo
Tucson
Summary
Demonstrated proficiency in handling expedited 72-hour turnaround requests and collaborating with medical directors to minimize claim denial rates, while consistently exceeding collection goals in revenue cycle management and patient financial services.
Professional appeals specialist prepared for roles that demand high standards and results-driven approach. Proven track record in managing complex appeals, leading to successful outcomes and enhanced procedural efficiency. Collaborative team player with focus on adaptability and achieving organizational goals. Strong skills in dispute resolution and regulatory compliance.
Overview
17
17
years of professional experience
Work History
Senior Grievance & Appeals Coordinator
Banner Health Plans & Networks
Tucson, AZ
07.2019 - 04.2026
- Handled complex member and provider complaints and appeals while maintaining compliance with state, federal, and NCQA regulations. Investigated cases, drafted response letters, and analyzed trends. Supported junior staff through mentoring and guidance.
Collector II
Praxis Healthcare Solutions
Plano, TX
11.2017 - 05.2019
- Assisted hospitals in recovering aged accounts receivable as a third-party vendor. Supported collection efforts for accounts over 120 days old. Collaborated with multiple facilities under Kindred Hospital and others across the U.S. Pursued payers for timely filing of aged accounts and underpayment reconsiderations. Achieved individual cash goals set by management each month.
Patient Financial Services
Banner University Medical Center
Mesa, AZ
02.2009 - 10.2017
- Assisted in billing and collection processes with follow-up support. Focused on Medicare, VA, BCBS, UHC, and workers’ compensation claims. Collaborated with border patrol and government-funded insurance programs. Followed up on AHCCCS claims and processed 1500 professional claims for IHS billing. Managed high-volume billing with an average of over 300 claims daily, consistently working overtime during holidays and weekends.
- Worked effectively in fast-paced environments.
Education
Certification - Medical Administrative Assistant
Pima Medical Institute
Tucson, AZSkills
- Executed accurate data entry processes to ensure information integrity
- Analyzed and interpreted policies to ensure compliance and clarity
- Analyzed and interpreted insurance regulations to ensure compliance and mitigate risks
- Safeguarded sensitive information to ensure confidentiality
- Ensured adherence to HIPAA regulations to protect patient privacy and confidentiality
- Facilitated effective communication strategies to enhance team collaboration
- Demonstrated exceptional analytical skills to drive data-informed decision-making
- Mastered medical terminology to enhance communication within healthcare teams
- Demonstrated proficiency in creating and managing comprehensive documentation systems
- Assisted clients in understanding insurance policies Supported team in processing policy applications Helped maintain accurate records of policy details
- Assisted teams in achieving project goals through effective communication and support Collaborated with colleagues to share knowledge and resources Contributed to a positive team environment by fostering cooperation and mutual respect
- Delivered exceptional customer service by addressing inquiries and resolving issues promptly
- Executed problem-solving strategies to identify and resolve operational challenges
- Optimized scheduling and prioritization of tasks to enhance productivity
- Appeals handling
- HIPAA compliance
- Patient confidentiality
- Claims processing
Demonstrated meticulous attention to detail in all tasks and projects
Timeline
Senior Grievance & Appeals Coordinator
Banner Health Plans & Networks
07.2019 - 04.2026
Collector II
Praxis Healthcare Solutions
11.2017 - 05.2019
Patient Financial Services
Banner University Medical Center
02.2009 - 10.2017
Certification - Medical Administrative Assistant
Pima Medical Institute