Bradley P. Cagle
Longview,TX
Summary
Proven Clinical Denials Specialist with a track record of maintaining work queues within a 30-day metric at UT Southwestern Medical Center and CVS Pharmacy. Excelled in communicating to improve business systems, identifying trends and immediately reporting them to management with emphasis on Medicare billing expertise. Collaborated effectively with teams to meet organizational goals, emphasizing results through innovation and adherence to guidelines. Additionally, called on by supervisors and managers from other teams with questions regarding hospice, home health and SNF billing.
Overview
8
8
years of professional experience
Work History
Clinical Denials Specialist I
UT Southwestern Medical Center
03.2019 - Current
- Maintained 10 work queues for EKG and hospice related services all within a 30 day metric.
- Followed all company policies and procedures to deliver quality work.
- Assisted in developing strategic plan that aligned with long-term company goals.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Daily work in Epic registration to add, terminate or update coverages for hospice and/or traditional Medicare.
- Submit redetermination requests to Medicare via their Novitasphere portal for EKG services and some hospice related services
Claims Adjudicator
CVS Pharmacy/Omnicare
08.2018 - 03.2019
- Collaborated with team members and management to meet goals.
- Maintained a work queue of pharmacy prescription requests within a 30 day metric
- Worked directly with local hospice facilities in Tarrant and Dallas Counties to provide products for their terminally ill patients.
- Followed internal guidelines for prescription refills.
Follow-Up Biller
Navigant Cymetrix
01.2017 - 03.2018
- Executed billing tasks and recorded information in company databases.
- Responsible for billing of recurring monthly services such as: chemotherapy, PT/OT, Radiation Therapy
- Tasked with ambulatory and outpatient billing for hospitals serving the North Carolina, Maryland and Illinois
- Countless dollars in charges followed up on, most of which were written off due to exceeding timely filing limits
Education
High School Diploma -
Riverview Community High School
Riverview, MI06.1988
Skills
- Management collaboration
- Advanced Communication
- Teamwork across the enterprise
- Epic registration
- Various payer platforms to review claim status
- Epic billing
- Medicare billing guidelines for hospice/home heatlh and SNF
Timeline
Clinical Denials Specialist I
UT Southwestern Medical Center
03.2019 - Current
Claims Adjudicator
CVS Pharmacy/Omnicare
08.2018 - 03.2019
Follow-Up Biller
Navigant Cymetrix
01.2017 - 03.2018
High School Diploma -
Riverview Community High School
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