Summary
Overview
Work History
Education
Skills
Timeline
Generic

Brandon Black

Houston,US

Summary

Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Overview

22
22
years of professional experience

Work History

Appeal Support

CloudMed Solutions
Remote
11.2022 - 06.2024
  • Call provider's office to check the status of appeals that were sent for review
  • Go on provider portal sites to check the status of appeals
  • Send request for further documentation to support appeal
  • Coordinate with team members to for denials reasons for appeals so second level of appeals can be sent
  • Use provider Epic systems to locate payments to be posted
  • Use provider Epic systems to provide payment history for team members.

Customer Service Representative

Inovalon/Complex Care Solutions
WFM
03.2020 - 11.2022
  • Call Doctor's office, Hospital, Urgent Care to locate medical records for patients to be submitted into system for insurance companies to document
  • Setup appointments for collectors to go to the medical facilities to collect medical records
  • Update provider's demographic information for further collection of records
  • Train newly hired reps the process of collecting records and setup appointments.

Poster

BG Staffing
Houston, TX
02.2020 - 03.2020
  • Process paper checks from insurance companies
  • Scan remits into the system for posting
  • Process declined claims and submit reason for denials to collectors for investigation
  • Use spreadsheet to calculate cash posting totals
  • Use IMS system to post insurance electronic payments
  • Use Availity system to look electronic remits copy and enter in IMS system.

Credit Balance Specialist

Mednax
Raleigh, NC
10.2017 - 12.2019
  • Determining if patient and insurance credits are valid
  • If credits are not valid to correct adjustments that would have made the credit in error
  • Contact insurance companies and patients to determine coordination of benefits to determine who is primary and secondary
  • Look at contracts to determine if allowables are correct, and determine if insurance over or underpaid

Collections Analyst

Mednax
Raleigh, NC
10.2017 - 12.2019
  • Looking at denials from insurance carriers to see the reason for the denial and determine what is needed to insure that insurances pay on anesthesia claims
  • Also to make sure that the claims are sent to the correct payors and if not submit request to have claims recharged and billed to correct payors
  • Another function is to call carriers to get clarification on the reason for a denial if not understood completely
  • Another function is to call patients to get them to update their insurance if needs to be updated
  • Contact surgeon's and hospitals to obtain documentation and forms needed for claims to be paid correctly.

Beneficiary Services Representative

Humana Military
Work at Home
09.2004 - 12.2017
  • Works collaboratively with Beneficiary Services Representative Team Leaders, supervisors, colleagues and other department contracts regarding clarification or interpretation of established guidelines
  • Sources direct applicable issues and questions to appropriate level and area within the departments
  • Actively educates beneficiaries regarding TRICARE plan enrollment and billing procedures and other health care issues by demonstrating a thorough knowledge of all TRICARE plans, benefits and entitlements
  • Identifies call and call inquiries
  • Documents calls through automated system and databases in accordance with established guidelines
  • Sources direct applicable issues and questions to appropriate level and area within the departments
  • Contributes and supports in the process and quality improvement initiatives
  • Participates and assigned research projects to analyze statistical data to support service operations
  • Maintains governmental database by entering new and updated customer and account information
  • Performs referral management duties by assembling information concerning patient's clinical background and building referral per established guidelines.

Technical Support Representative

Pegasus Satellite Company
Louisville, KY
07.2002 - 09.2004
  • Delivered service and support to end-users using and operating automated call distribution phone software, via remote connection or over the Internet; Interacted with customers to provide and process information in response to inquiries, concerns, and requests about products and services; Gathered customer's information and determine the issue by evaluating and analyzing the symptoms; Diagnosed and resolve technical hardware and software issues involving internet connectivity, email clients, IPTV, VOIP and more; Researched required information using available resources Followed standard processes and procedures Identified and escalate priority issues per Client specifications Redirected technical problems and other issued to the appropriate resource Accurately process and record call transactions using a computer and designated tracking software; Offer alternative solutions where appropriate with the objective of retaining customers' and clients' business;Organize ideas and communicate oral messages appropriate to listeners and situations; Follow up and make scheduled call backs to customers where necessary; Stay current with system information, changes and updates

Education

High school or equivalent -

Wakefield High School
Arlington, VA
08.1997

Skills

  • Microsoft Office
  • Powerpoint
  • VPN
  • LAN
  • Epic Systems
  • Availity
  • IMS
  • Customer Service
  • Multitasking
  • Time Management
  • Phone Experience
  • Detail-oriented
  • Teamwork
  • Problem Solving
  • Data Entry
  • Troubleshooting
  • Research
  • Documentation
  • Claims Processing
  • Attention to Detail
  • Critical Thinking
  • Verbal and Written Communication
  • Insurance
  • Medical Records
  • Appointments
  • Cash Posting
  • Insurance Claim Forms Review
  • Small Claims Payouts
  • Eligibility Determination
  • Teamwork and Collaboration
  • Background in Insurance
  • Allocating Claims

Timeline

Appeal Support

CloudMed Solutions
11.2022 - 06.2024

Customer Service Representative

Inovalon/Complex Care Solutions
03.2020 - 11.2022

Poster

BG Staffing
02.2020 - 03.2020

Credit Balance Specialist

Mednax
10.2017 - 12.2019

Collections Analyst

Mednax
10.2017 - 12.2019

Beneficiary Services Representative

Humana Military
09.2004 - 12.2017

Technical Support Representative

Pegasus Satellite Company
07.2002 - 09.2004

High school or equivalent -

Wakefield High School

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Brandon Black