Breanna DeBouse
Nashville,TN
Summary
Proven track record in enhancing patient satisfaction and streamlining insurance processes, Skilled in policy analysis and emotional awareness, Excel in teamwork and problem-solving, achieving significant improvements in efficiency and client support. Expertise in relationship building drives optimal outcomes in fast-paced healthcare environments.. Outstanding analytical, interpersonal and organizational skills. Dedicated to expediently resolving insurance issues and exceeding client expectations. Detail-oriented individual with exceptional communication and Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Proven success in improving operations and solving problems. Highly proficient in building lasting relationships with key decision makers, customers and team members to further company goals. Ready to leverage training and experience to take on new professional challenges.
Overview
10
10
years of professional experience
Work History
Health Plan Advisor
United Healthcare Group
02.2024 - 10.2024
- Conducted comprehensive assessments to determine appropriate health plan offerings for individual needs.
- Established trust among clients through transparent communication regarding policy details and pricing structures.
- Provided ongoing support to enrolled members, addressing concerns or issues related to their chosen health plans.
- Assisted members in navigating complex insurance policies, simplifying their understanding of coverage benefits.
- Enhanced member satisfaction by providing personalized health plan recommendations and support.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
Benefit Verification Specialist
CVS Health
07.2023 - 01.2024
- Managed high-volume claims up to 40 per day while maintaining strict deadlines for completing benefit verifications and authorizations.
- Provided exceptional customer service by addressing patient concerns regarding coverage and out-of-pocket expenses.
- Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy.
- Improved patient satisfaction by accurately verifying benefits and providing timely responses to inquiries.
- Served as a subject matter expert for peers and supervisory staff, providing guidance on best practices in benefit verification processes.
- Collaborated with cross-functional teams to address discrepancies in patient information, ensuring accurate billing and reimbursement.
Administrative Assistant
Insight Global
01.2022 - 07.2023
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Maintained confidentiality of sensitive information by adhering to strict privacy policies and implementing secure filing systems.
- Ensured accurate record-keeping with diligent data entry and database management for vital company information.
- Improved document organization with thorough file maintenance, archiving outdated records as necessary for efficient retrieval when needed.
- Assisted with Covid-19 contact tracing using protocols.
Reimbursement Specialist
RemX, McKesson Specialty
11.2019 - 06.2020
- Provided exceptional customer service when responding to patient inquiries about reimbursement status and procedures, while keeping them updated on claim status progressions at all stages of the process.
- Delivered timely information to insurance representatives to resolve common and complex issues.
- Achieved timely reimbursements approximately 30 incoming for clients through diligent follow-ups with insurance carriers.
- Optimized claim submission procedures by regularly reviewing payer requirements and updating internal documentation accordingly.
- Streamlined communication between departments to facilitate accurate information exchange and improve case management efficiency.
- Increased client satisfaction with comprehensive claim review, ensuring accuracy and compliance with policy guidelines.
Prior Authorization Representative
Cigna
11.2018 - 09.2019
- Managed to complete 30-40 incoming pharmacy prior authorizations cases daily.
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
- Verified eligibility and compliance with authorization requirements for service providers.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Collected structured clinical data processed new medication and refill requests for authorization.
- Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
Customer Service Representative
Xerox
01.2015 - 06.2017
- Managed 50-60 inbound calls daily in high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Resolved complex employee issues regarding benefit coverage disputes or claim processing delays by working collaboratively with insurers.
- Educated new hires on available benefit options.
- Facilitated seamless transitions between benefit providers when necessary due to mergers/acquisitions or plan changes.
- Assisted in the management of FMLA/LOA requests, ensuring timely processing and accurate tracking of leaves taken.
- Assisted employees with benefit options.
- Managed benefits administration for company-wide staff, ensuring timely processing and accurate recordkeeping.
- Enhanced employee satisfaction by implementing streamlined HR policies and procedures.
- Administered employee benefits programs and assisted with open enrollment.
Education
Some College (No Degree) -
Rio Salado Community College
Tempe, AZHigh School Diploma -
La Joya
Phoenix, AZSkills
- Financial Acumen
- Policy analysis
- Teamwork and Collaboration
- Time Management
- HR services
- Attention to Detail
- Organization and Multitasking
- Benefits administration
- Relationship Building
- Decision-Making
- Emotional awareness
- Patient support
- Customer relations
- Complex Problem-solving
Additional Information
Project management certification pending -Currently enrolled through Coursera
• Foundations of Project Management -Completed May, 2024
• Project Initiation: Starting a Successful Project -Completed June, 2024
• Project Planning: Putting it All Together-Completed July, 2024
• Project Execution: Running the Project- Completed August, 2024
Timeline
Health Plan Advisor
United Healthcare Group
02.2024 - 10.2024
Benefit Verification Specialist
CVS Health
07.2023 - 01.2024
Administrative Assistant
Insight Global
01.2022 - 07.2023
Reimbursement Specialist
RemX, McKesson Specialty
11.2019 - 06.2020
Prior Authorization Representative
Cigna
11.2018 - 09.2019
Customer Service Representative
Xerox
01.2015 - 06.2017
Some College (No Degree) -
Rio Salado Community College
High School Diploma -
La Joya
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