Brian Martin
Blackwood,NJ
Overview
20
20
years of professional experience
1
1
Certification
Work History
Claims Examiner
AmeriHealth Caritas
Philadelphia, PA
06.2012 - Current
Analyze,
research, and adjudicate professional/facility claims at all levels of
complexity for one of the largest Medicaid managed care organizations in the U.S.
Determine level of reimbursement based on established criteria, regulatory guidelines, provider contracts and plan provisions for multiple lines of business including South Carolina, Kentucky, New Jersey and Florida.
Analyze services for appropriateness of charges and system edits, and determine exclusions and denials based on contract provisions.
Audit claims to identify examiner and system configuration errors.
Extensive knowledge of claims validation, medical terminology, diagnostic/procedural coding, standard claim forms (CMS-1500/CMS UB-04), EDI, DRG, NDC, NIA, reference materials (PDR, CPT, ICD-9 and HCPCS), coordination of benefits and interpretation of contracts.
Determine level of reimbursement based on established criteria, regulatory guidelines, provider contracts and plan provisions for multiple lines of business including South Carolina, Kentucky, New Jersey and Florida.
Analyze services for appropriateness of charges and system edits, and determine exclusions and denials based on contract provisions.
Audit claims to identify examiner and system configuration errors.
Extensive knowledge of claims validation, medical terminology, diagnostic/procedural coding, standard claim forms (CMS-1500/CMS UB-04), EDI, DRG, NDC, NIA, reference materials (PDR, CPT, ICD-9 and HCPCS), coordination of benefits and interpretation of contracts.
Production Planner Coordinator
SONY DADC
Pitman, NJ
06.2008 - 02.2009
Planned, scheduled, released and tracked workflow in the
manufacturing department for one of the world’s largest entertainment
corporations in the world.
Supervised, coordinated and prioritized production personnel/activities to meet customer, plant and management requirements.
Minimized production time and costs, efficiently organized the use of resources and maximized efficiency on the production floor.
Determined/adjusted human resource, machine and material requirements for multiple production projects.
Prepared daily production reports that covered inventory, production rates and progress, equipment issues, scheduling delays, labor productivity and impediments to efficiency and productivity.
Supervised, coordinated and prioritized production personnel/activities to meet customer, plant and management requirements.
Minimized production time and costs, efficiently organized the use of resources and maximized efficiency on the production floor.
Determined/adjusted human resource, machine and material requirements for multiple production projects.
Prepared daily production reports that covered inventory, production rates and progress, equipment issues, scheduling delays, labor productivity and impediments to efficiency and productivity.
Child Support Specialist
New York State Office of Temporary and Disability Assistance
Albany, NY
11.2005 - 08.2007
Evaluated,
planned and analyzed processes and techniques (quantitative and qualitative) to
ensure program integrity and improve efficiency of sixty-two New York State
county child support enforcement units.
Identified training needs and arranged for appropriate training directly to county support enforcement staff.
Drafted new or amended policy and procedural publications to accommodate legislative/regulatory changes and programmatic impacts.
Served as liaison to the U.S. Department of State regarding the child support enforcement passport denial mechanism and collaborated with U.S. embassies/consulates to explain/resolve revoked passports of U.S. nationals behind in their child support payments.
Reconciled both IRS and New York State Department of Taxation and Finance tax refund intercepts.
Built and maintained strong positive relationships with key stakeholders (Federal, State and Local) through stakeholder analysis, engagement and management.
Demonstrated high level of skill in effective project management including the coordination and implementation of complex research and evaluation projects.
Identified training needs and arranged for appropriate training directly to county support enforcement staff.
Drafted new or amended policy and procedural publications to accommodate legislative/regulatory changes and programmatic impacts.
Served as liaison to the U.S. Department of State regarding the child support enforcement passport denial mechanism and collaborated with U.S. embassies/consulates to explain/resolve revoked passports of U.S. nationals behind in their child support payments.
Reconciled both IRS and New York State Department of Taxation and Finance tax refund intercepts.
Built and maintained strong positive relationships with key stakeholders (Federal, State and Local) through stakeholder analysis, engagement and management.
Demonstrated high level of skill in effective project management including the coordination and implementation of complex research and evaluation projects.
Education
MPA - Public Administration
Rutgers University
2005
Bachelor of Arts - Political Science
Rutgers University
1996
Skills
- Program evaluation
- Project planning
- Medical terminology expert
- Research and data analysis
- Data analysis
- Advanced computer skills
Timeline
Claims Examiner
AmeriHealth Caritas
06.2012 - Current
Production Planner Coordinator
SONY DADC
06.2008 - 02.2009
Child Support Specialist
New York State Office of Temporary and Disability Assistance
11.2005 - 08.2007
MPA - Public Administration
Rutgers University
Bachelor of Arts - Political Science
Rutgers University