Brian Emerick
Montgomery,AL
Summary
SKILLS SUMMARY Insurance policy coverage knowledge Administrative Background Policy Investigations Claims Analyst Subrogation Expert Data Analysis MS Office Oracle Database Strong Client Relations Maintains Healthcare Confidentiality 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
20
20
years of professional experience
Work History
Recovery Specialist II
Cahaba GBA
Birmingham, AL
08.2013 - Current
- Responsible for the recovery of mistaken liability, no-fault, and workman’s compensation claims where the beneficiary must repay Medicare
- Work with liability, workers compensation, auto and no-fault carriers, reviewing claims paid by Medicare and ensuring claims attached to the case are related to the date of incident in question
- Safeguarding the beneficiary's PHI is protected by reviewing the representative and the type authorization attached to ensure the chain of authorization is within guidelines
- Reviewing previous correspondence to confirm the authorization type is entered correctly
- Working with disputes filed by attorneys, third party administrators and beneficiaries
- Communicate with attorneys, TPA's and insurance companies as needed
- Initiate recovery steps in accordance with laws set for each category and in accordance with guidelines established by the Centers for Medicare and Medicaid Services
- Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims
- Reviewed new files to determine current status of injury claim and to develop a plan of action
- Maintained contact with claimants and attorneys to determine treatment status
- Substantiated legitimate claims and denied unjustified claims.
Patient Account Supervisor
University of Alabama at Birmingham, School of Dentistry
08.2012 - 01.2013
- Supervised billing personnel and maintained performance statistics
- Coordinated third party claims systems
- Assisted in establishing and administering billing and collections processes and procedures
- Performed system analysis of employees’ daily and weekly operating procedures
- Identified procedural inefficiencies and inequities such as patient and insurance billing errors
- Retrained staff to effectively perform daily/weekly tasks
- Confirmed daily monetary deposits with patient account representatives.
Customer Service Manager
Advanced Insulin Management
04.2009 - 07.2012
- Responsible for training new hires for customer service department
- Assisted with processing new referrals and provided product and insurance coverage knowledge to customers in a fast-paced environment
- Established open communication with the Reimbursement Department to configure customer service policies and operations, as well as with customer service representative regarding billing codes update and insurance coverage modification
- Maintained staff efficiency, as well as identified operational inefficiencies and unproductive areas through effective daily and weekly analysis on employee’s operations
- Applied effective listening, interpersonal, and business communication skills to determine customers' needs.
Patient Care Coordinator
Pinnacle Medical Solutions
07.2007 - 01.2009
- Communicated with customers by phone and received orders for diabetic testing and insulin pump supplies
- Solicited sales of new and/or additional services
- Employed interpersonal skills in coordinating with independent sales team members to monitor their business progress and performance growth, as well as identifying customer needs
- Coordinated customer service through communication with clients and distribution
- Consistently met or exceeded personal and sales team monthly quotas and was instrumental in contributing to additional profits; increased annual sales
- Collaborated with doctors’ offices and pharmacists to coordinate prescription modifications to acquire necessary laboratory results to meet health insurance guidelines.
Patient Representative
Accredo Nova Factor
06.2004 - 07.2007
- Contacts benefit providers to gather policy benefits/limitations to ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
- Ensures accounts requiring authorizations and re-authorizations are identified, secured, and updated in RX Home prior to each shipment
- Handle claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issues
- Work with other operational departments to research and resolve claims issues within performance agreement guidelines
- Input claim requests into adjudication platform and evaluating system rejections to ensure accuracy.
Education
Bachelor of Arts in English for Corporate Communications & Management -
Christian Brothers University
Skills
- Insurance policy coverage knowledge
- Administrative Background
- Policy Investigations
- Claims Analyst
- Subrogation Expert
- Data Analysis
- MS Office
- Oracle Database
- Strong Client Relations
- Maintains Healthcare Confidentiality
- Teamwork and Collaboration
- Attention to Detail
Timeline
Recovery Specialist II
Cahaba GBA
08.2013 - Current
Patient Account Supervisor
University of Alabama at Birmingham, School of Dentistry
08.2012 - 01.2013
Customer Service Manager
Advanced Insulin Management
04.2009 - 07.2012
Patient Care Coordinator
Pinnacle Medical Solutions
07.2007 - 01.2009
Patient Representative
Accredo Nova Factor
06.2004 - 07.2007
Bachelor of Arts in English for Corporate Communications & Management -
Christian Brothers University
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