BRIANA BLAKE
Nashville,Tennessee
Summary
Dynamic and results-driven professional with extensive experience in patient services, insurance verifications, medical billing and coding, and office administration. Recognized for a strong commitment to aligning with business priorities, organizing data efficiently, prioritizing projects effectively, and driving process improvements. Expertise in enhancing operational billing processes and developing innovative solutions for patient and client challenges. Seeking to leverage a diverse skill set in a role focused on accounts receivable, billing, or insurance verification to contribute to organizational success and maximize business objectives.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Insurance Verification Representative
Community Health Systems (CHS)
03.2025 - Current
- Verifies insurance benefits, eligibility, and predetermination requirements for all scheduled patients, ensuring accuracy and completeness before services are rendered.
- Coordinates with physician offices to obtain required pre-authorizations and pre-certifications, preventing reschedules or cancellations due to missing approvals.
- Confirms patient coverage for procedures and treatments, documenting insurance details, policy limitations, and reimbursement expectations.
- Initiates financial counseling for uninsured or underinsured patients, referring them to financial assistance programs or payment plan options.
- Accurately documents and updates patient records, including pre-certification numbers, eligibility details, and authorization statuses.
- Communicates effectively with patients and physician offices, providing clear information regarding insurance coverage, financial responsibilities, and payment expectations.
- Ensures timely entry of pre-registration documents into the electronic health record (EHR) and forwards them to the appropriate department.
- Maintains accurate department records, reports, and documentation, ensuring compliance with billing, regulatory, and facility policies.
- Identifies and resolves insurance discrepancies, proactively addressing issues that could result in billing errors or claim denials.
- Works collaboratively with case management, patient registration, and billing teams, ensuring seamless revenue cycle operations and optimized reimbursement.
- Performs other duties as assigned.
- Collaborated with healthcare providers to resolve discrepancies in patient insurance information.
- Verified insurance eligibility and benefits for patients to ensure accurate billing processes.
- Utilized electronic health record systems to maintain up-to-date patient data and documentation.
- Analyzed claims denials and implemented corrective actions to improve authorization success rates.
- Process between 30-40 verifications a day.
Patient Service Representative
Nashville General Hospital
06.2024 - 03.2025
- Assisted with training new staff on the policies and procedures of the Patient Access Department.
- Participated in the hospital rounding with the physicians, scheduled appointments upon discharge using ECW along with the scheduling guidelines to assure accuracy in scheduling.
- Serves as a super user and assistant trainer for the upcoming system upgrade implantation to Cerner.
- Created training documentation and manuals for the Patient access department for Cerner.
- Registered patient information into the system upon entering the emergency department. Verified all patient demographics and insurance information was updated as needed, also provided appointments to patients upon the provider request from the ED.
- Generated reports to discharge all patients that needed to be discharged with the correct date and discharge time.
- Analyze the current workflow to be able to assist agents with making corrections in the scheduling and insurance process. Received direction from the director of financial services to assist with corrections on accounts, and to also help assist with updating accounts in Parallon to be able to get claims flowing.
- Managed patient scheduling and appointment confirmations to optimize clinic workflow.
- Ensured accurate patient registration by verifying insurance information and demographic details.
- Collaborated with healthcare providers to address patient inquiries and resolve issues promptly.
- Trained new staff on hospital protocols, enhancing team efficiency and service quality.
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Facilitated patient registration by accurately entering demographic and insurance information into electronic health record systems.
Pharmacy Technician
Walgreens Pharmacy
11.2021 - 12.2024
- Achieve objectives by preparing labels and filling prescriptions accordingly with pre-packaging common medications that resulted in faster order completions.
- Maintain strict inventory control by monitoring stock levels, performing regular audits, and promptly ordering supplies to prevent shortages.
- Processed and dispensed medications accurately to ensure patient safety and compliance.
- Provided exceptional customer service by addressing inquiries and resolving prescription-related issues promptly.
- Implemented workflow improvements that reduced prescription processing time while maintaining accuracy standards.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- 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.
- Analyze and verify/enter new patient data, input billing information as well, and contact patients concerning co-payment, payment methods & any quote changes.
- Expertly navigates insurance systems, codes, and billing processes to maximize reimbursement while minimizing denials.
- Utilize Aged Receivables Report as well as monitor outstanding insurance claims and actively follow up on pending payments, consistently reducing accounts receivable.
- Collaborate closely with patients, explaining insurance coverage and payment options, leading to increased patient satisfaction and on-time payments.
- Serve as a liaison between the oral surgeons, patients, and insurance companies, facilitating effective communication and conflict resolution when needed.
- Managed patient insurance verification processes to ensure accuracy and compliance with industry standards.
- Developed and maintained efficient filing systems for insurance documents and patient records.
- Implemented process improvements that reduced claim denial rates through meticulous documentation practices.
- Trained staff on insurance protocols and software usage to enhance operational efficiency.
- Analyzed insurance policy changes to update office procedures and inform staff accordingly.
- Verified insurance and communicated coverage to staff and patients.
- Assisted clients with understanding complex insurance policies, effectively addressing concerns or questions.
- Maintained goal of 30 insurance verifications a day.
Medical Quality Assurance Specialist
OTC Management | Ajilon
12.2021 - 07.2022
- Worked directly with the VA, providers, and claimants including placing outbound phone calls to provider’s offices to gather additional information for cases to be passed through for processing with the VA.
- Conducted thorough reviews and audits of medical evaluation reports, ensuring compliance with company guidelines, industry standards, and government regulations.
- Collaborated with medical providers to address deficiencies and discrepancies in reports, facilitating clear and concise communication to improve report quality.
- Participated in the development and implementation of quality assurance policies, procedures, and training programs for medical staff and support teams.
- Served as a subject matter expert on healthcare compliance, staying up-to-date with relevant regulations and ensuring company-wide adherence.
- Conducted comprehensive quality audits to ensure compliance with industry standards and regulatory requirements.
- Developed and implemented testing protocols for software applications, enhancing product reliability and performance.
Verification Specialists
Brookdale Home Health Care
10.2018 - 11.2020
- Conducted thorough verification of patient information, insurance eligibility, and authorizations to ensure accurate billing and reimbursement processes.
- Maximized efficiency by assisting with retrieval and processing of incoming insurance verification requests from local communities for outpatient, home health, or hospice services via inbound and outbound phone calls.
- Monitored HCHB EMR System for workflows related to prior authorization needs to ensure sufficient authorization was always available to provide patient care.
- Maintained compliance with healthcare regulations, including HIPAA, and consistently met or exceeded all quality assurance standards.
- Reviewed and validated patient documentation for compliance with regulatory standards.
- Coordinated verification processes to ensure timely and accurate patient data management.
- Analyzed discrepancies in patient records, implementing corrective action.
- Maintained goal of completing 40+ verifications in one day.
Patient Service Representative
University Community Health Services
08.2015 - 10.2018
- Obtained current patient information from established and new patients as well as accurately entered patients and updated patient information in the practice management system.
- Scheduled patient appointments, Verified insurance eligibility and noted patient arrival in Electronic Health Record (EHR).
Education
Diploma - Medical Billing and Coding
Ultimate Medical Academy
01.2022
High School Diploma -
Mcgavock High School
Nashville, TN05-2007
Skills
- Data Analysis and Reporting
- Medical Terminology
- Strategic Planning
- Financial Analysis
- Relationship Building
- Effective Communication
- Collaborative Teamwork
- Exceptional Customer Service
- Office Software and Applications: Microsoft Office Suite (MS Excel, MS Word, MS PowerPoint and MS Outlook)
- Communication Platform: MS Teams, Zoom, and Skype
- Microsoft office
- HIPAA compliance
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
- Auditing Financial Records
- Insurance Verification
- Data Confidentiality and Privacy
- Process Improvement
- Anatomy and Physiology
- HIPAA Compliance
Languages
English
Timeline
Insurance Verification Representative
Community Health Systems (CHS)
03.2025 - Current
Patient Service Representative
Nashville General Hospital
06.2024 - 03.2025
Insurance Coordinator
OMS Nashville: Oral Surgery
07.2023 - 06.2024
Medical Quality Assurance Specialist
OTC Management | Ajilon
12.2021 - 07.2022
Pharmacy Technician
Walgreens Pharmacy
11.2021 - 12.2024
Verification Specialists
Brookdale Home Health Care
10.2018 - 11.2020
Patient Service Representative
University Community Health Services
08.2015 - 10.2018
Diploma - Medical Billing and Coding
Ultimate Medical Academy
High School Diploma -
Mcgavock High School