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, CASkills
- 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