Nikole Stern
St Paul
Summary
Prior Authorization Appeals Specialist with extensive experience at Tactile Medical, excelling in clinical documentation and claims analysis. Proven ability to draft compelling appeal letters and interpret payer policies, while fostering collaboration across teams. Recognized for enhancing appeal success rates through proactive communication and strong relationship-building skills.
Overview
6
6
years of professional experience
Work History
Prior Authorization Appeals Specialist
Tactile Medical
Minneapolis
04.2025 - Current
- Review clinical documentation to support appeal efforts and determine appeal viability.
- Draft appeal letters and statements of medical necessity addressing payer medical policy requirements.
- Communicate relevant information effectively to clinicians, patients, and field representatives.
- Identify positive and negative payer trends and escalated findings to management proactively.
Associate Analyst, Medicare Appeals
Tactile Medical
Minneapolis
05.2023 - 04.2025
- Managed multiple projects simultaneously while meeting strict deadlines.
- Collaborated with cross-functional teams to ensure timely completion of projects.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Responded to inquiries regarding claim status updates from providers and patients.
Medicare Specialist
Tactile Medical
Minneapolis
04.2019 - 05.2023
- Reviewed medical records and checklist documentation to meet Medicare's medical necessity criteria.
- Facilitated communication between Tactile Medical, clinicians, healthcare teams, and patients to finalize orders.
- Collaborated with internal departments to ensure successful Medicare submission processes.
- Developed strong relationships with field personnel to enhance teamwork and collaboration.
Education
High School Diploma -
Roseville Area High School
Roseville05-1993
Skills
- Clinical documentation and claims analysis
- Appeal letter drafting
- Payer policy interpretation
- Medical necessity assessment
Timeline
Prior Authorization Appeals Specialist
Tactile Medical
04.2025 - Current
Associate Analyst, Medicare Appeals
Tactile Medical
05.2023 - 04.2025
Medicare Specialist
Tactile Medical
04.2019 - 05.2023
High School Diploma -
Roseville Area High School
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