MONIQUE MOORE-BROWN

CLAIMS ANALYST

AZ

520-***-****

ad1ad9@r.postjobfree.com

OBJECTIVE

Strengthening Business Relationships while Utilizing Developmental Skills to Enhance Customer Experiences through Ethically Productive Reinforcement of Company Standards.

EDUCATION & LICENSES —

EXPERIENCE

Business Healthcare Management, LA, Remington College

2010-2012

AS in Computer Electronics, IL,

Olive Harvey College,

1984-1987

H.S Diploma, IL,

Bowen High School,

1978-1982

Certified Pharmacy Technician _ ARIZONA BOARD OF PHARMACY

PTCB - Pharmacy Technician Certification Board (PTCB)

(Exp. 09/30/2024) _ Pharmacy Technician Certification Board

National Pharmacy Technician

2020-PRESENT

Patient Care Technician • AZ • Express Scripts

Manage Hundreds of Claims by Directing Litigation Processes Across Several Healthcare Sectors, with Attorneys & Insurance Companies, to Acquire, Maintain & File Reports in Patient Records.

Resolve Intricate Procurement Issues Raised in Pull Department.

Virtual Copying, Faxing, Data Entry, Transcription from Customer Support Interactions, & Manage Overall Communications to Elucidate Patient Benefits.

Initiate Investigations for Prescription Orders.

Perform Follow Up Calls on Prior Authorization, Appeals, & DOD Accounts.

2016-2020

Claims Analyst • AZ • Centene Corporation

Refined Electronic & Paper Claims for both Medicaid & Hospitals.

Analyzed, Reviewed, & Updated Claims for Accuracy, Completeness & Eligibility Review in order to meet Billing Requirements & Payer Demands.

Actively Managed Claims Process to Ensure Timely Resolution for Validity of Records.

Identified & Denied Duplicate Claims.

Team Lead Investigator of Missing Claims, Provider Info & EOB Accounts & Calculations.

Input Proper ICD-9/10 & CPT Codes & Attached Flawless Referral/Authorizations.

Reviewed Med. Records for Optimal DRG Assignment & Reported Findings to Coding Manager.

Coded High $/Volume Inpatient Records (Cardio, Radio, Gastro, Neuro, etc.).

Implemented State of the Art Formulas to Improve & Monitor Workflow for Daily/Weekly QA Status Reports.

Recognized as The Top 10 Analyst for Exceeding Accuracy & Attendance Goals by 98%.

Utilized Amisys to Determine Payment & Rejection Codes.

2015-2016

Insurance Specialist • AZ • REMX Ltd.

Entry, Audit, & Confirmation of Claims Data & Preferred Payments.

Processed Re-Verifications by contacting Existing Clients' Insurance Providers & Prior Authorizations.

Applied D.0 Regulations & Coding Guidelines to Claims Data; -4, ICD-9, ICD-10, HCPCS, ASA, & UB92 Codes/Billing Guidelines.

2014-2015

Certified Pharmacy Technician• AZ • Q O L Meds

Prescription Prep; Data Entry of Patient Demographics, Drug Allergies, Pharmaceutical History & Orders.

Superb Customer Service Skills while Greeting Patients, Phone Reception, & Filing.

Maintained Drugstore Cleanliness, Pulled/Stocked, Poured, Counted, Restock/Packaging, Labeling & Pricing Prescriptions, Mail Order, Balancing Cash POS & Sending in Receipts to Corporate.

KEY SKILLS —

PRIOR EXPERIENCE

Microsoft Office365 Software (Windows10, Word, Excel, PowerPoint, Publisher, and Access).

Customer Service

Claims Investigation

Complaint Resolution

QA

Risk Management Support & Reporting

Relationship Building

Patient Care Technician, AZ & LA, UnitedHealth Group, 2013-2014

Certified Pharmacy Technician, LA, Walmart Supercenter Pharmacy 2012-2013

Pharmacy Technician, LA, GPS PHARMACY-TAMPA LLC 2008-20011

Electronic Technician, LA, EARL K LONG HOSPITAL 2000-2008

CTA & CATS Bus Operator, IL & LA, LSU Students from 1993-2013

Tax Agent for Jackson Hewitt in Chicago IL 1990-1993

Oscar Mayer Ambassador 1984-1989

Dental Assistant 1982-1985

REFERENCES

Available Upon Request

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