title: A day in the life of managed care: Health Alliance Plan's Medicare Appeals Specialist Yolanda Dodson.
abstract: Yolanda Dodson began working for Health Alliance Plan (HAP) as a high school co-op student. Through 11 years in HAP's Claims and Claims Processing Departments, as well as six months spent as a telephone customer service representative, she developed a knowledge of managed care and customer service and gained valuable first-hand experience with members' concerns. Now Dodson is a Medicare Appeals Specialist, one of two staff people handling HMO and HAP Senior Plus (HAP's Medicare+Choice program) grievances and appeals. She serves as an "advocate for the member" as she investigates their cases within a tight mandatory deadline, recommends a resolution, and submits them for consideration to HAP medical directors. The following is a glimpse at one her typical days at HAP's Detroit offices.
mesh_terms: D000288:Administrative Personnel; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007587:Job Description; D008329:Managed Care Programs; D008824:Michigan; D017008:Negotiating