Jennifer Brown

**** ******** ****** ** **** ***

Antioch, TN 37013

918-***-****

Objectives

To find a position that provides me the opportunity to demonstrate my abilities and to expand them for future endeavors. I am customer service oriented, well-organized, creative, and a problem solver.

Education

Attended Lee University for a BA in English; incomplete

Graduated cum laude Central HS Rapid City, SD 1998

Skills

Type 100 + WPM

10,000 + kph 10 key

Familiar with Microsoft Office 2003, XP, 2007, 2010, 2013 and 365

Experienced Customer Service Specialist

Experience working with mobile devices including smart phones, including troubleshooting

Experience troubleshooting PCs- both software and hardware

Familiarity with Lotus Notes and Outlook Exchange email programs as well as Lync/Skype

Expert in proofreading/editing; including contract documents

Experience

Claims Examiner II, Quality Assurance Audit Lead (REMOTE)

Integrated Home Care Services (Miramar, FL) April 2021-Feb 2022, Feb 2022-present

Production based environment, trained on Plexis based claims processing system. Moved to project team to help correct and prevent errors by other examiners. Advocated for creation of QA lead position and establishment of auditing protocols. Assisted in creation and editing of claims policy and procedure, trained multiple new examiners on use of systems and proper QA processes. Onboarded new claim system, HRP and identified issues and developed workarounds for the issues in that system. Provided back up for provider service calls including EOBs, claims adjusting and payment details. Currently working both Plexis and Health Edge claims processing systems.

Claims Analyst/Recovery Analyst (Feb 2018-March 2021)

Equian, LLC (now Optum) (Franklin, TN) call 1-800-***-**** to verify

Production based recovery analysis for Humana. Created new recovery concepts, streamlined current concepts, and provided responses to provider disputes regarding recovery claims. While it was not part of the job description, I also helped train several fellow employees who were either hired with me or hired after me to understand the systems and intricacies of the Humana platform, and helped my co-workers understand and process the concepts that I helped write. Suggested for there to be a central searchable database regarding queries that would provide processing guidelines for each concept for ease of quality assurance and for learning new concepts.

Appeals Analyst (December 2016-Feb 2018)

CGS Administrators (Nashville, TN) call 855-***-**** to verify

Production based claims processing for DME (Durable Medical Equipment) Medicare redeterminations for Jurisdiction C. Taught to read and understand LCD and policy articles related to Medicare determinations as well as provide feedback to patients and providers about documentation or reasons for denial of payment. Training production expectations were 1.5 claims analyzed per hour. This metric was met 2 weeks before training concluded. Once off of training, was expected to analyze and process 4 claims per hour amortized over an 8 hour workday. (32 claims/day) Regularly exceeded these expectations. Cross trained in Customer Service for provider inquiries as of 1/3/18.

PSS Verizon Tech Coach (Sept 2016-November 2016)

Asurion (Nashville, TN) go to thomasandcompany.com, use code ASUR456 to verify

Response based customer service call center. Duties include answering customer calls and troubleshooting all devices supported by Verizon Wireless, especially cell phones. Issued replacement phones when troubleshooting was not effective, and transferred calls to other departments where appropriate. Learned Verizon systems including ACSS which houses customer account information and Asurion specific systems such as Soluto -which is the program they use to document calls and how they are handled, such as if the issue is resolved or if the customer was transferred to another department. One of the most important features in this system is the call reason/sub reason, as that allows management to track trends in calls.

Provider Analysis Specialist (August 2015-May 2016)

Blue Cross Blue Shield of OK (Tulsa, OK) call 866-***-**** to verify

Responsibilities include providing correct provider coding for claims processing as well as accurately and efficiently loading provider data into the provider database. This includes setting up providers for hospital privileges and networks, whether they have contracts for themselves or through the hospital. Regularly checked individual providers to verify that all information in our system matched up with the provider’s own records.

Claims Processor/Examiner (September 2010-August 2015)

BCBSOK (Tulsa, OK)

Processor responsibilities include learning HIPAA compliance as well as procedure/diagnosis codes and processing multiple lines of business including ASO, HMO, PPO and Medicare/Medicaid. Productivity, or the speed of handling claims was the main performance indicator. A productivity percentage of 65% was considered average. This percentage was measured by analyzing how much time was actually spent processing claims vs researching, restroom breaks, and lunch time. My productivity was at 72% when I left this role. Average number of claims handled per day was 160. Quality checks were done weekly- at first, as a new examiner, 5 claims per week were chosen at random to ensure the highest quality. As quality was proven, that number was reduced to 3 claims per week. Out of 156 claims pulled for the 2014 year, only 3 claims were found to have errors.

Examiner duties also included accurately determining coordination of benefits, routing of claims to the correct department and assisting in training new hires to process claims accurately and efficiently. Became one of two subject matter experts whose main job was analyzing and determining the correct order of Coordination Of Benefits, especially pertaining to patients who had multiple coverage with different Blue Cross/Blue Shield products.

Additional work history available upon request

References:

Jason Panks 615-***-**** adyxo5@r.postjobfree.com

Robin Romano 502-***-**** adyxo5@r.postjobfree.com

Theresa Raffaele 360-***-**** adyxo5@r.postjobfree.com

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