Customer Service Continuous Improvement
Resume:
BRIAN
YOUNG
*******@*****.***
Houston TX
Bold Profile
Experienced Managed Healthcare professional with 15 years of expertise in continuous improvement and value enhancement. Committed to achieving superior results and boosting productivity daily, emphasizing team success and collaboration. Specializing in managed healthcare insurance, proficient in IDC-10, CPT, and HCPCS codes for Medicare/Medicaid replacement plans. Skilled in claims status, appeal status, claims processing, adjudication, and claim denial troubleshooting. Authorized to work in the US for any employer. PROFESSIONAL SUMMARY
SKILLS
Appeal Intake
Specialist/Medicare Appeal
Coordinator (7 years)
•
• CUSTOMER SERVICE (8 years)
EXCELLENT MULTITASKER (10+
years)
•
• ICD-10 knowledge
Able to adapt to fast paced Team
player/positive attitude
environment
•
Proficient on any current version
of Microsoft Windows, Microsoft
Office and Microsoft Outlook
•
Fast enthusiastic learner and
Active listener and excellent
verbal willing participant skills
•
Efficient on multiple
platforms/applications
simultaneously
•
Bellaire High School
Bellaire, TX • 06/1992
High School Diploma
EDUCATION
CENTENE/WELLCARE - Medicare Appeal Coordinator/Intake Specialist Houston, TX • 09/2018 - Current
UNITEDHEALTHCARE - Senior Provider Service Representative/Intake Coordinator
Sugar Land, TX • 05/2010 - 08/2018
WORK HISTORY
In my role of Medicare Appeal Specialist, my duties included review of denied claims, managing appeals, and ensuring accurate payments. Daily functions included various tasks, including reviewing documentation, posting payments, corresponding with involved parties, and writing appeal letters. I have worked with both Original Medicare and Medicare Advantage plans(Part C), navigating the specific appeal processes for each.
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Responsibilities included providing detail status for professionals and May 2010-Aug 2018 facility claims, plan benefit information, creating claim reconsideration request and initiating prior authorization request. Claim status includes disclosure of payment or denial information and complete breakdown of the explanation of benefits for UHC Community Plan members. My duties included working with new hires on team and providing informal training in daily responsibilities.
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