Jean Brayboy

**** ** *** **

Graham NC, *****

910-***-****

acoi1l@r.postjobfree.com

Objective: To acquire a position that will allow me to fully utilize my Professional and Medical skills and knowledge.

Experience:

UNC Healthcare

4/2011 to Current

Patient Financial Service Representative

: Processing adjustments to patient accounts and answering correspondence from multiple sources.

: Corresponding with insurance carriers in all aspects via phone, email or fax to obtain prior authorization and benefits for all elective and ER inpatient and outpatient medical/surgical services.

: Corresponding with workers compensation on all cases that are deemed a workers comp case and follow up with obtaining authorization for services from Adjustors.

: Direct contact with North Carolina Department of Correction on all ER, elective inpatient and outpatient cases to obtain authorization.

: Direct contact with Medicaid and Carolina Access to assure that authorization is obtained for CPT codes that they have specified needing authorization.

: Direct contact with NC Track for verification of Medicaid coverage as well as working with NC Tracks for overrides when NPI are not correct

: Reviewing with insurance carriers and well as schedulers and physicians that all ICD9 and CPT codes are correct prior to patient procedures.

: Interrupts clinical to obtain correct ICD9 and CPTS codes and authorization.

: I am the insurance specialist for all Hillsborough GI cases and United Healthcare vascular cases .

: I work directly with the Rehabilitation Case Managers at UNC, insuring the verification process have been completed for a patient admission to Rehab.

Blue Cross and Blue Shield of New Mexico Quality Department

May 2005- Nov 2010

Customer Service Quality Auditor/Coach

: Auditing Customer Service using Nice and EPPS. Entering and recording quality results into the EPPS system

: Responsible for reviewing random samples of all levels of advocates. Auditing each item to determine if the out come was appropriate

: Providing quality results to Supervisors and advocates to enhance performance

: Identifying and communicating training needs to management

: Performed random analysis of call error and make recommendation to management for areas of improvement.

Blue Cross and Blue Shield Provider Service Unit

June 2002- May 2005

Customer Service Advocate III

: Answered incoming calls from Providers/Members/Brokers/ other insurance carriers. Average calls taken per day 35-50

: Experienced in working with all lines of business such as PPO, EPO, HCA, POS, HMO, Medicaid, Medicare and Medicare supplemental plans.

: Provided provider and member education on how their claims processed and paid. Researched appeals sent in by the members and providers.

: Responsible for researching policy, procedure and guidelines regarding group benefits and inquiry processing.

: Assisted with new customer service trainees in navigating the BCBS systems (dashboard, blue star, acrobat and quoting of benefits) before they were assigned to a unit. Assisted in training new advocates on how to provide excellent Concierque Customer Service.

: Assisted others advocates in handling member/provider inquiries by verbally responding to questions regarding benefit/claims.

Blue Cross and Blue Shield Indian Health Service

August 1998- June 2002

Customer Service Advocate I & II

: Answered incoming call from providers regarding status of claims/purchase orders.

: Researched and processed purchase orders for all of the Indian Health facility throughout the United States

: Provided provider education on how to complete purchase orders

New Mexico Urology Group

Oct 1997- August 1998

Scheduler and Coordinator

: Scheduled appointment and surgeries for the attending physician

: Gather Medical history to prepare charts for new patients

: Schedule x-rays/labs/and procedure perform that the hospital.

: Collected copays, coinsurance.

: Verified insurance and obtain authorization

: Assisted Physician with simple procedures

New Mexico Heart Institute

Oct 1993- Oct 1997

Account Service Rep

: Responsible for handling patient accounts

: Responsible for resolving denied claim from insurances carriers for these accounts.

: Setting up collection accounts for patient balances

: Responsible for setting payment arrrangement account that where self pay.

Presbyterian Hospital

1989-1993

Patient Escort

Phlebotomist

Pathology lab

Surgery Scheduler

Education:

Central Carolina Community College

Complete Classes for:

Electronic Health Records Data

Medical Coding ICD 9 and 10

Cpt

References:

Dawn Harris: College Teacher: 919-***-****

Denise Henderson-Supervisor: 336-***-****

Juanita William-Manager: 336-***-****

Interest:

Play softball, camping, dancing, fishing, hanging out with my kids

.

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