Monique Moore-Brown

Claims Analyst

Tempe, AZ

adwcj4@r.postjobfree.com

Highly analytical professional with extensive experience managing numerous claims and directing litigation processes across healthcare sectors. Instrumental in collaborating with management to resolve multifaceted issues and ensure excellent quality of processes. Skilled in training and leading high caliber teams to administer day-to-day functions and achieve business objectives. Adept at acquiring informative data, preparing detailed reports, and securing confidential records. Proficient in developing strong working relationships with clients, maintaining claims files organized, and collaborating attorneys to settle cases. Excel at analyzing complicated insurance data by coordinating with insurance representatives and monitoring payment progress. Possesses comprehensive understanding of the laws and guidelines concerning medical claims.

Areas of Expertise

Claims Investigation

Patient Satisfaction

Quality Assurance

Management Support & Reporting

Strong Relationship Building

Cross-functional Collaboration

Customer Service

Risk Management Support

Complaint Resolution

Professional Experience

Express Scripts – Tempe, AZ 2020 – Present

Patient Care Technician

Address issues, raised in Pull department. Perform tasks associated with Pull Rx, involving pulling, copying, and processing. Enter data, transcribe notes from customer support interactions, and manage overall member communications. Navigate through number of different systems. Assist patients in better understanding pharmacy benefits. Investigate current as well as previous prescription orders.

●Returned calls from members and providers and placed calls to providers and members for follow-up and advice on issues such prior authorization, appeals, and DOD accounts.

Centene Corporation – Tempe, AZ 2016 – 2020

Claims Analyst

Processed Electronic & Paper Claims for both Medical & Hospital/Analyzed & Reviewed Claims for Accuracy, Completeness & Eligibility/Responsible for Editing Claim after Review to meet Billing Requirements & Payer Demands/Actively Managed the Process of a Claim to Ensure Appropriate & Timely Resolution/Identified & Denied Duplicate Claims/ In Charge of Conducting Research & Investigation of Claims missing Provider info & EOB Calculations/Input Correct ICD-9/10 & CPT Codes & EOB Amounts & Attached Correct Referral or Authorization/Reviewed Med Recs for Optimal DRG Assignment & Reported findings to Coding Manager/Audited-Coded High Dollar & High Volume Complex Inpatient Records(Cardio, Radio, Gastro, Neuro, etc.)Maintained Records & Correspondence Related to Work/Meticulously Identified & Rectified Inconsistencies/Assisted in Special Projects such as Implementing New Methods to Improve Work Flow/Provide Daily & Weekly Status Reports Enhancing the Decision Making Process in an Effort to Improve the Quality of Service

Recognized for One of the Top Analyst for Exceeding Goal with an Accuracy of 98% & Perfect Attendance.

●. Researched and determined status of medical related claims, reviewed costs, used Amisys to determine payment and rejection codes within specified department norms and standards.

REMX Ltd. – Phoenix, AZ 2015 – 2016

Insurance Specialist

Gained experience in auditing, reviewing, and validating accuracy of claims data and accuracy of claims payment preferred. Tasked with processing re-verification claims, calling existing clients' insurance providers, entering necessary data for processing claims, and obtaining previous authorizations. Applied published healthcare guidelines, such as D.0 regulations and coding guidelines to claims data.

●Utilized knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA, and UB92 Codes, and billing guidelines required.

Q O L Meds – NEW ORLEANS, PHOENIX AZ 2014 – 2015

Certified Pharmacy Technician

Supported with preparation of prescriptions, including entering patient information (demographics, drug allergies and pharmaceutical history) and prescription orders into computer for processing. Greeted with customers, maintained drugstore clean, and answered phone politely. Provided support to pharmacist in filling prescriptions by pulling stock, pouring, counting, restocking, packaging, and labeling and pricing prescription, bubble packing, mail order, balancing cash drawer and sending in receipt to corporate.

●Managed product quality through placing orders, receiving goods, rotating stock, and storing items.

AHS PharmStat – Edmond, OK 2013 – 2014

Certified Pharmacy Technician

Supported pharmacist in filling prescriptions by pulling stock, pouring, counting, restocking, packaging, labeling, and pricing the prescription.

●Maintained patient information private in accordance with HIPAA laws as well as retained all product labels, signs and prices aligned with product.

Additional Experience

Patient Care Technician, UnitedHealth Group – Phoenix, LA

Certified Pharmacy Technician, Walmart Supercenter Pharmacy – Gonzales, LA

Pharmacy Technician, GPS Pharmacy– Gonzales, LA

Electronic Technician, Earl K Long Hospital– Baton Rouge, LA

Education

Business Healthcare Management

Remington College – Baton Rouge, LA

Associate Degree, Computer Electronics

City Colleges of Chicago – Chicago, IL

Licenses & Certifications

Certified Pharmacy Technician _ ARIZONA BOARD OF PHARMACY

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

National Pharmacy Technician

Technical Proficiencies

Microsoft Office Software (Windows7, Word, Excel, PowerPoint, Publisher, and Access).

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