BRIANA BLAKE
Nashville,TN
Summary
Detail-oriented professional with extensive experience in insurance verification and patient services. Skilled in analyzing claims, ensuring accurate documentation, and enhancing patient communication, leading to better service delivery. Aiming to utilize this expertise to drive success in accounts receivable and insurance verification.
Overview
1
1
Certification
11
11
years of professional experience
Work History
Payor Portal Data Entry Specialists
Addison Group/ Specialty Dental Brands (Project Based) (Contract Position)
02.2026 - 04.2026
- Coordinated implementation of payor portal access for multiple dental offices, improving administrative efficiency across locations.
- Negotiated and secured portal access permissions with leading healthcare organizations, facilitating smoother operations.
- Executed precise data entry in company databases, maintaining high standards of accuracy and thoroughness.
- Implemented streamlined data entry procedures, reducing errors and boosting productivity.
- Leveraged advanced spreadsheet capabilities for improved data analysis and organizational efficiency.
- Monitored progress towards achieving weekly goal of 100 portals, ensuring consistent performance and service delivery.
Insurance Verification Representative
Community Health Systems (CHS)
02.2025 - 08.2025
- Verified eligibility and predetermination requirements for all scheduled patients, ensuring accuracy prior to service delivery.
- Coordinated with physician offices to secure pre-authorizations and certifications, reducing cancellations by ensuring timely compliance.
- Identified and resolved insurance discrepancies, preventing potential billing errors and denials.
- Analyzed claims denials and implemented corrective measures, improving authorization success rates.
- Maintained up-to-date records on electronic health record systems, documenting eligibility and authorization statuses.
- Processed between 30 and 40 verifications each day, facilitating smooth operational workflows.
- Ensured accurate documentation of patient records, including pre-certification numbers and eligibility details.
- Communicated effectively with both patients and physician offices regarding coverage details and payment expectations.
Patient Service Representative
Nashville General Hospital
06.2024 - 12.2024
- Verified patient demographics and insurance information, facilitating appointment requests from ED providers.
- Collaborated with physicians during hospital rounding to ensure accurate discharge scheduling using ECW.
- Generated discharge reports to verify correct discharge dates and times for all patients.
- Trained new staff on hospital protocols, improving service quality and team efficiency.
- Served as super user and assistant trainer for upcoming Cerner system upgrade implementation.
- Created training documentation and manuals for patient access department regarding Cerner.
- Analyzed current workflow to assist agents in correcting scheduling and insurance processes.
- Collaborated with director of financial services on account corrections and updates in Parallon.
Pharmacy Technician
Walgreens Pharmacy ( Part Time)
11.2021 - 12.2024
- Processed and dispensed medications accurately to ensure patient safety and compliance.
- Prepared labels and filled prescriptions with pre-packaged common medications, contributing to faster order completions.
- Resolved customer issues in-person and over the phone by assisting with order placements, system navigation, and item location.
- Responded to incoming phone calls, addressing inquiries from customers and healthcare providers to enhance communication.
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Assisted in maintaining a clean and organized work environment, ensuring compliance with safety regulations.
Insurance Coordinator
OMS Nashville: Oral Surgery
07.2023 - 06.2024
- Successfully verify insurance coverage and benefits for patients, ensuring accurate information is on file before procedures.
- Managed patient insurance verification processes to ensure accuracy and compliance with industry standards.
- Utilized Aged Receivables Report to monitor outstanding insurance claims and actively followed up on pending payments, consistently reducing accounts receivables.
- Collaborated with patients to explain insurance coverage and payment options, enhancing patient satisfaction and promoting on-time payments.
- Analyze and verify/enter new patient data, input billing information as well, and contact patients concerning co-payment, payment methods & any quote changes.
- Facilitated effective communication and conflict resolution between oral surgeons, patients, and insurance companies.
- Trained staff on insurance protocols and software usage, improving operational efficiency.
- Assisted clients with understanding complex insurance policies, effectively addressing concerns or questions.
- Achieved target of verifying 30 insurance claims daily.
Medical Quality Assurance Specialist
QTC Management | Ajilon (Contract Position)
12.2021 - 02.2022
- Performed comprehensive reviews and audits of medical evaluation reports, ensuring strict adherence to company guidelines, industry standards, and government regulations.
- Served as subject matter expert on healthcare compliance, maintaining current knowledge of regulations and fostering adherence across the company.
- Collaborated with VA, providers, and claimants, placing outbound calls to gather critical information for case processing with the VA.
Verification Specialists
Brookdale Home Health Care
10.2018 - 08.2019
- Conducted thorough verification of patient information, insurance eligibility, and authorizations to ensure accurate billing and reimbursement processes.
- Streamlined retrieval and processing of insurance verification requests from local communities for outpatient, home health, and hospice services through effective inbound and outbound communication.
- Maintained compliance with healthcare regulations, including HIPAA, and consistently met or exceeded all quality assurance standards.
- Coordinated verification processes, enhancing timely and accurate management of patient data.
- Analyzed discrepancies in patient records, implementing corrective action.
- Completed over 40 verifications daily, supporting accurate billing and reimbursement.
Patient Service Representative
University Community Health Services
08.2015 - 10.2018
- Scheduled patient appointments and verified insurance eligibility, accurately recording patient arrivals in Electronic Health Record (EHR) to facilitate timely care.
- Scheduled patient appointments and coordinated with healthcare providers.
- Verified patient insurance eligibility and collected necessary documentation.
- Obtained and updated patient information in practice management system, ensuring accurate records for both established and new patients.
- Addressed patient inquiries to provide accurate information about services. and provided information on hospital services.
Education
High School Diploma -
Mcgavock High School
Nashville, TN05-2007
Diploma - Medical Billing and Coding
Ultimate Medical Academy
Clearwater, FL01-2022
Skills
- Insurance Verification
- Data Entry Accuracy
- Claims Analysis
- HIPAA Compliance
- Medical Terminology
- Scheduling and Appointment Management
- Patient support
- Collaborative Teamwork
- Effective Communication
Certification
- HIPAA Essentials for Healthcare Professionals Certificate; Ultimate Medical Academy
- Medical billing and coding Certificate
- Pharmacy Tech License
SUMMARY OF QUALIFICATIONS
- Proven expertise in managing insurance claims, patient billing, and facilitating seamless communication between patients, providers, and insurance companies.
- Adept at verifying insurance coverage, resolving billing discrepancies, and ensuring optimal reimbursement.
- Strong analytical and problem-solving skills with a keen attention to detail.
- Exceptional interpersonal and communication abilities to collaborate effectively with clients and colleagues.
- Medical Coding (ICD-9-CM, ICD-10-CM, HCPCS and CPT)
- Electronic Health Records (EHR)
- Electronic Medical Records (EMR)
- Billing Report Preparation
- Data Confidentiality and Privacy
- Process Improvement
- HIPAA Compliance
Timeline
Payor Portal Data Entry Specialists
Addison Group/ Specialty Dental Brands (Project Based) (Contract Position)
02.2026 - 04.2026
Insurance Verification Representative
Community Health Systems (CHS)
02.2025 - 08.2025
Patient Service Representative
Nashville General Hospital
06.2024 - 12.2024
Insurance Coordinator
OMS Nashville: Oral Surgery
07.2023 - 06.2024
Medical Quality Assurance Specialist
QTC Management | Ajilon (Contract Position)
12.2021 - 02.2022
Pharmacy Technician
Walgreens Pharmacy ( Part Time)
11.2021 - 12.2024
Verification Specialists
Brookdale Home Health Care
10.2018 - 08.2019
Patient Service Representative
University Community Health Services
08.2015 - 10.2018
High School Diploma -
Mcgavock High School
Diploma - Medical Billing and Coding
Ultimate Medical Academy