Brian Becker
Phoenixville
Summary
Results-driven management professional with proven ability to lead teams to success. Strong focus on team collaboration, operational efficiency, and achieving measurable outcomes. Adept at strategic planning, process improvement, and fostering culture of accountability and excellence. Known for adaptability and consistently meeting changing organizational needs.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Manager Clinical/Coding Payment Resolution
Trinity Health
11.2021 - Current
- Promoted to manager after eight months with organization. Team oversight of 56 colleagues and 3 supervisors.
- Team responsible for claim denials based on coding issues and all post-payment audits for 48 acute care facilities across 15 states.
- Collaborated in development of both coding and clinical denial playbooks.
- Continue to develop workflow resource documents to improve standardization for audit accounts impacting all acute care facilities.
- Optimized Epic functionality to improve workflow and increase efficiency.
- Collaborate with acute care facility service line leads, case management and compliance teams to appeal, track and develop denial prevention strategies related to audits.
- During time as manager, number of acute care facilities with post-payment audits has grown, yet total account backlog has decreased. This is the result of improved workflow and optimization of team member functionality.
- Develop training strategies for both front line colleagues and supervisors.
Clinical Payment Resolution Specialist
Trinity Health
03.2021 - 11.2021
- Appealed both claim and audit denials for a variety of reasons including, but not limited to: inpatient medical necessity, readmission, DRG downgrade, no authorization and outpatient procedure denials.
Retrospective Appeals Clinical Coder and Nurse Supervisor
Optum Physician Advisor Solutions an Optum360 company
03.2012 - 03.2021
- Began as Retrospective Government Appeals Nurse and was promoted to Supervisor within four months.
- Began working with Retrospective Medicare Appeals, but when the company underwent a workforce reduction I was tasked with supervising and developing the Retrospective Commercial Appeals team.
- Initiated and developed team of nurses to act as expert witnesses for Medicare Medical Necessity Appeals at Administrative Law Judge hearings
- Historically underperforming team of clinical coders and clinical validation appeals nurses placed under my supervisor. Increased productivity Metrics to within and exceeding company expectations.
- Maintain and update process instructions for Clinical Validation and Coding appeals. Previous had same role for medical necessity appeals process instructions.
- Participated in training, teaching and monitoring multiple nurse training classes, as well as training physicians in some information technology updates.
- Acted as lead supervisor and organizer in numerous projects throughout time in supervisor role.
- Actively participated in initiation, training, and continued monitoring and development of Filipino Appeals Nurse team in Manila, Philippines.
- Maintain oversite of Clinical Validation/Coding Appeals team in Manila Philippines
Emergency Department Nurse
The Chester County Hospital
10.2006 - 03.2012
- Direct patient care of patients throughout life span who present with various physical and mental health care emergencies.
- Triage patients as they initially present to Emergency Department. Triage includes initial medical assessment and patient history, sorting patients to Fast Track or Acute Emergency Department based on Emergency Service Index levels and prioritizing patients based on acuity of emergency.
- Have performed as charge nurse of thirty-one bed acute care emergency department and six bed fast track unit. Duties have included organization of staff assignments, coordinating flow of patients from triage or ambulance into department then to admission, facility transfer or discharge.
- Have also certified patients, through insurance or county funding, for admittance into mental health facilities or drug and alcohol detox and rehab facilities.
- Have performed as preceptor for graduate nurses, new to unit nurses, student nurses and paramedic students.
Travel Nurse
American Mobile Healthcare
04.2001 - 09.2006
- Employed as travel nurse completing eleven assignments of duration from thirteen weeks to nine months. Completed all assignments with invitations to return if opportunity presented.
- Direct patient care in various units throughout the hospitals. Units worked have included Progressive Care Units, cardiothoracic surgery, telemetry, Express Admission Unit, and renal transplant unit.
- Have been called upon to displayed flexibility and adaptability through “floating” within hospital to various units not excluding Intensive Care Unit and Emergency Department.
- Have performed as preceptor for graduate nurses, new to unit nurses and nursing students.
- At times have been called upon to perform role of charge nurse overseeing unit operation, staffing assignments and patient care.
Staff Nurse
Saint Joseph’s Hospital
01.1999 - 04.2001
- Began as patient care assistant. Advanced to staff nurse after passing NCLEX exam.
- Direct patient care of cardiothoracic surgery patients and post cardiac catheterization patients. Patient population required nurses with strong organizational and prioritizing skills.
- Charge nurse of 25 bed unit coordinating admission, transfer, and discharge of unit patients, while maintaining own team of patients.
- Frequently assisted in scheduling needs to fill holes and optimize nurse to patient ratios.
- Have performed as preceptor for graduate nurses, new to unit nurses and nursing students.
Education
Bachelor of Science - Nursing
Kennesaw State University
Kennesaw, Georgia05.1999
Associate degree - Specialized Technology/Hospitality Management
The Restaurant School
Philadelphia, Pennsylvania08.1991
Skills
- Customer service
- Team leadership
- Time management
- Decision-making
Certification
- Certified Professional Coder
- From AAPC received September 2022
- Certified Revenue Cycle Representative
- From HFMA received October 2021
Awards
UnitedHealth Group 2018 Sages of Clinical Service
Timeline
Manager Clinical/Coding Payment Resolution
Trinity Health
11.2021 - Current
Clinical Payment Resolution Specialist
Trinity Health
03.2021 - 11.2021
Retrospective Appeals Clinical Coder and Nurse Supervisor
Optum Physician Advisor Solutions an Optum360 company
03.2012 - 03.2021
Emergency Department Nurse
The Chester County Hospital
10.2006 - 03.2012
Travel Nurse
American Mobile Healthcare
04.2001 - 09.2006
Staff Nurse
Saint Joseph’s Hospital
01.1999 - 04.2001
Associate degree - Specialized Technology/Hospitality Management
The Restaurant School
Bachelor of Science - Nursing
Kennesaw State University