Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

Brent Leslie

Woodland Hills,CA

Summary

Forward-thinking Operations Specialist bringing 15+ years of expertise in processing for the Health Insurance sector. Experience enhancing operations for organizations through information systems solutions. Track record of transforming specific goals related to efficiency improvements into new system designs. Knowledgeable auditor known for recommending new trainings to enhance workflow and operations. Cultivates rapport with individuals to optimize project goals and output, resolve complex issues and deliver improvement strategies.

Overview

14
14
years of professional experience

Work History

Auditing Analyst

Centene
06.2019 - Current
  • Identified and resolved problems through root cause analysis and research.
  • Performed system analysis, documentation, testing, implementation, and user support for platform transitions.
  • Recommended process improvements to continually identify, analyze and fix constraints and challenges.
  • Validated results and performed quality assurance to assess accuracy of data.
  • Identified clear connections between policies and business results to eliminate or reduce confusion and help employees achieve goals.
  • Optimized core processes to improve business performance and operational agility.
  • Monitored compliance and filing requirements in conjunction with staff and management.
  • Conducted regular reviews of operations and identified areas for improvement.
  • Managed quality reports on offshore employees.

Appeals and Grievances Coordinator

HealthNet Of California
03.2015 - 06.2019
  • Collects, organizes and tracks information to facilitate and expedite processing of appeals received from a variety of sources.
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.
  • Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
  • Submitted verbal and written notification to members and providers.
  • Entered appeal requests in appeals module.
  • Skilled at working independently and collaboratively in a team environment.
  • Worked flexible hours across night, weekend and holiday shifts.
  • Paid attention to detail while completing assignments.
  • Cultivated interpersonal skills by building positive relationships with others.
  • Excellent communication skills, both verbal and written.
  • Organized and detail-oriented with a strong work ethic.
  • Adaptable and proficient in learning new concepts quickly and efficiently.
  • Assisted with DMHC, URAC and Health Plan audit preparation.

Medical Review Coordinator

Advanced Medical Review
06.2014 - 03.2015
  • Entered data, generated reports, and produced tracking documents.
  • Set priorities and problem-solved workflow issues to maintain rapport between vendors and providers.
  • Gathered and organized medical documents to support authorization requests.
  • Tracked records, filed documents and maintained communication between stakeholders to manage office activities.

Utilization Review Specialist (Lead)

CID Management
09.2011 - 09.2013
  • Performed prior authorization review of services requiring notification.
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Performed admission reviews based for medical necessity based upon requests without prior authorization (N.P.A.)
  • Supervised multiple employees in a time sensitive environment.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.

Administrative Assistant

Providence Hospital And Medical Center
12.2009 - 09.2011
  • Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
  • Executed record filing system to improve document organization and management.
  • Scheduled office meetings and client appointments for employee teams.
  • Received and sorted incoming mail and packages to record, dispatch, or distribute to correct recipient.
  • Created and maintained databases to track and record employee data.
  • Processed employee certifications accurately and within agreed timeframes to meet necessary standards.

Education

In Progress - Business Administration And Management

Santa Monica College
Santa Monica
12.2025

High School Diploma -

North Hollywood Highschool
North Hollywood
06.2005

Skills

  • Attention to Detail
  • Process Improvement
  • Root Cause Analysis
  • Risk Mitigation
  • Audit Support
  • Regulatory understanding
  • Interdepartmental Communication
  • Staff Supervision
  • Case Management
  • Database Management
  • Electronic Health Records
  • Quality Control

Additional Information

- Dedicated Father

- Animal Lover

- Hiking Enthusiast

- Videogame Connoisseur

Timeline

Auditing Analyst

Centene
06.2019 - Current

Appeals and Grievances Coordinator

HealthNet Of California
03.2015 - 06.2019

Medical Review Coordinator

Advanced Medical Review
06.2014 - 03.2015

Utilization Review Specialist (Lead)

CID Management
09.2011 - 09.2013

Administrative Assistant

Providence Hospital And Medical Center
12.2009 - 09.2011

In Progress - Business Administration And Management

Santa Monica College

High School Diploma -

North Hollywood Highschool

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Brent Leslie