Summary
Overview
Work History
Education
Skills
Timeline
Generic

Bradley Griffith

Fiddletown,CA

Summary

Detail-oriented compliance auditor specializing in regulatory analysis and claims processing. Proven ability to enforce policies and conduct thorough audits to enhance quality assurance in medical billing.

Overview

15
15
years of professional experience

Work History

Business Operations Claims Oversight Auditor

Centene
Sacramento, California
06.2012 - Current
  • Conducted claim audits to ensure compliance with regulatory standards.
  • Experience with Medicare, Medi-Cal, and Marketplace state guidelines and regulations.
  • Customer Service Lead, including escalations, and staff supervision.
  • Medical Management worked closely with Nursing and the Medical Director, clarifying medical policies regarding pre-authorization for providers and members.

Customer Service Representative

Spherion Staffing
El Dorado Hills, California
11.2011 - 2012
  • Assisted customers with inquiries through phone and email communications.
  • Resolved customer complaints by identifying issues and providing solutions.
  • Maintained accurate records of customer interactions and transactions.

Education

High School Diploma -

River City Senior High School
West Sacramento, CA

Skills

  • Compliance auditing
  • Regulatory analysis
  • Claims processing
  • Policy enforcement
  • Medical billing
  • Quality assurance

Timeline

Business Operations Claims Oversight Auditor

Centene
06.2012 - Current

Customer Service Representative

Spherion Staffing
11.2011 - 2012

High School Diploma -

River City Senior High School

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Bradley Griffith