Brandy Arakawa
Glendale,CA
Summary
Dynamic healthcare operations leader with over 15 years of experience in eligibility management, enrollment, and benefits administration within health plans and provider networks. Expertise in managing 270/271 electronic file transactions, ensuring compliance, and implementing workflow automation to optimize processes. Skilled at leading cross-functional teams to drive continuous improvement initiatives, delivering accurate and timely eligibility and benefits data. Recognized for enhancing operational efficiency, minimizing errors, and maintaining regulatory compliance while consistently providing exceptional service to patients, providers, and health plans.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Issue Control Coordinator
BC Forward / Elevance Health
02.2024 - 03.2024
- Processed Life and Disability enrollment applications, ensuring accuracy and timely updates.
- Maintained and validated membership records in proprietary systems to support benefit administration.
Enrollment Configuration Analyst
Clever Care Health Plan
07.2020 - 01.2024
- Developed documentation supporting CMS enrollment workflows, enhancing compliance and audit readiness.
- Provided technical expertise for multi-system implementations, collaborating with vendors to resolve testing issues.
- Reviewed and updated CMS exhibits to ensure adherence to regulatory and policy standards.
- Led process automation initiatives, reducing manual workload and improving team efficiency.
Customer Service Solutions Supervisor
L.A. Care Health Plan
11.2019 - 06.2020
- Supervised team performance, ensuring compliance with healthcare regulations and quality standards.
- Conducted audits and provided coaching to improve accuracy and service delivery.
- Facilitated team meetings to identify challenges and implement operational improvements.
- Supported recruitment and onboarding by interviewing candidates and mentoring new hires.
Eligibility Director
Network Medical Management
04.2018 - 10.2019
- Directed eligibility operations, overseeing strategic planning, resource allocation, and reporting.
- Led concurrent healthcare projects, delivering results aligned with organizational goals.
- Reconciled monthly health plan eligibility data with 100% accuracy, ensuring compliance.
- Mentored staff and fostered a culture of accountability and professional growth.
Eligibility Manager
SynerMed
09.2013 - 03.2018
- Implemented eligibility policies in compliance with state and federal guidelines.
- Created reports from eligibility audits to inform leadership decisions and compliance efforts.
- Partnered cross-functionally to improve workflows and policy alignment.
- Developed and delivered training programs to strengthen staff expertise and performance.
Eligibility Supervisor
SynerMed
03.2006 - 08.2013
- Supervised eligibility team, processing health plan data and reconciling electronic files.
- Designed and delivered training programs for updated eligibility procedures.
- Collaborated with health plans, provider offices, and internal departments for issue resolution.
- Streamlined workflows by leading process improvement initiatives.
Patient Specialist
Family Medicine Physicians
11.2005 - 03.2006
- Verified insurance eligibility and benefits for patients.
- Coordinated patient scheduling, referrals, and prior authorizations.
- Prepared medical charts and communicated prescription information to pharmacies.
Education
High School Diploma -
Whittier High School
Whittier, CA01.1992
Skills
- Eligibility management
- Knowledge of CMS and HIPAA regulations
- Efficiency enhancement
- Team leadership
- Electronic file processing
- Project execution and coordination
- Data quality management
- Customer service expertise
- Proficient in MS Office Suite
- Issue resolution
- Data validation
- Compliance auditing
- Workflow automation
Certification
- Google – Prepare Data for Exploration
- Google – Process Data from Dirty to Clean
- Google – Data-Driven Decisions
- Google – Foundations: Data
Timeline
Issue Control Coordinator
BC Forward / Elevance Health
02.2024 - 03.2024
Enrollment Configuration Analyst
Clever Care Health Plan
07.2020 - 01.2024
Customer Service Solutions Supervisor
L.A. Care Health Plan
11.2019 - 06.2020
Eligibility Director
Network Medical Management
04.2018 - 10.2019
Eligibility Manager
SynerMed
09.2013 - 03.2018
Eligibility Supervisor
SynerMed
03.2006 - 08.2013
Patient Specialist
Family Medicine Physicians
11.2005 - 03.2006
High School Diploma -
Whittier High School