Summary
Overview
Work History
Education
Skills
Timeline
Generic

Brian Young

Houston,TX

Summary

Experienced Managed Healthcare professional with 15 years of expertise in continuous improvement and value enhancement. Committed to achieving superior results and boosting productivity daily, emphasizing team success and collaboration. Specializing in managed healthcare insurance, proficient in IDC-10, CPT, and HCSPC codes for Medicare/Medicaid replacement plans. Skilled in claims status, appeal status, claims processing, adjudication, and claim denial troubleshooting. Authorized to work in the US for any employer.

Overview

15
15
years of professional experience

Work History

Medicare Appeal Coordinator/Intake Specialist

CENTENE/WELLCARE
09.2018 - Current
  • In my role of Medicare Appeal Specialist, my duties included review of denied claims, managing appeals, and ensuring accurate payments. Daily functions included various tasks, including reviewing documentation, posting payments, corresponding with involved parties, and writing appeal letters. I have worked with both Original Medicare and Medicare Advantage plans(Part C), navigating the specific appeal processes for each.

Senior Provider Service Representative/Intake Coordinator

UNITEDHEALTHCARE
05.2010 - 08.2018
  • Responsibilities included providing detail status for professionals and May 2010-Aug 2018 facility claims, plan benefit information, creating claim reconsideration request and initiating prior authorization request. Claim status includes disclosure of payment or denial information and complete breakdown of the explanation of benefits for UHC Community Plan members. My duties included working with new hires on team and providing informal training in daily responsibilities.

Education

High School Diploma - undefined

Bellaire High School
Bellaire, TX
06.1992

Skills

  • Appeal Intake Specialist/Medicare Appeal Coordinator (7 years)
  • CUSTOMER SERVICE (8 years)
  • EXCELLENT MULTITASKER (10 years)
  • ICD-10 knowledge
  • Able to adapt to fast paced Team player/positive attitude environment
  • Proficient on any current version of Microsoft Windows, Microsoft Office and Microsoft Outlook
  • Fast enthusiastic learner and Active listener and excellent verbal willing participant skills
  • Efficient on multiple platforms/applications simultaneously

Timeline

Medicare Appeal Coordinator/Intake Specialist

CENTENE/WELLCARE
09.2018 - Current

Senior Provider Service Representative/Intake Coordinator

UNITEDHEALTHCARE
05.2010 - 08.2018

High School Diploma - undefined

Bellaire High School

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Brian Young