BRIANA BLAKE
Summary
Dynamic and results-driven professional with extensive experience in insurance verifications, billing, and patient services. Recognized for aligning with business priorities, organizing data efficiently, and enhancing operational processes. Expertise in verifying insurance authorizations and financial counseling, seeking to leverage a diverse skill set in a role focused on accounts receivable and insurance verification to contribute to organizational success at Ascension Health.
Overview
1
1
Certification
11
11
years of professional experience
Work History
PSS coordinator
Trudata RX
Brentwood, TN
09.2026 - Current
- Resolved and logged inquiries from Walmart associates regarding plan change letters, ensuring clear communication and understanding.
- Managed administrative tasks to support prior authorization processes related to prior authorizations and appeals
- Assisted clinical team in conducting thorough prior authorization case reviews, facilitating informed decision-making.
- Facilitated outbound calls to members and providers for clinical team, enhancing engagement and support.
- Completed various projects and tasks
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 dental office locations, enhancing administrative efficiency.
- Engaged with healthcare organizations to negotiate portal access permissions, facilitating streamlined operations.
- Implemented streamlined data entry procedures, resulting in reduced errors and increased productivity.
- Performed data entry tasks in company databases, maintaining precision and thoroughness in all entries.
- Leveraged advanced spreadsheet capabilities to enhance data analysis and improve organizational efficiency.
- Monitored progress towards achieving weekly goal of 100 portals, ensuring consistent service delivery.
Patient Service Representative
Nashville General Hospital
06.2024 - 12.2025
- Delivered exceptional customer service to patients, resolving inquiries and concerns to enhance patient experience.
- Ensured accurate patient registration by verifying insurance information and demographic details.
- Registered patient information into the system upon entering the emergency department. Verified all patient demographics and insurance information was updated.
- Participated in hospital rounding with physicians and scheduled appointments upon discharge using ECW and scheduling guidelines to ensure accuracy in scheduling.
- Acted as super user and assistant trainer for system upgrade to Cerner, facilitating knowledge transfer and user readiness.
- Developed training documentation and manuals for patient access department, ensuring staff proficiency with Cerner system.
- Trained new staff on hospital protocols, enhancing team efficiency and service quality.
Insurance Verification Representative
Community Health Systems (CHS)
02.2025 - 08.2025
- 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.
- Communicated with patients and physician offices, clarifying insurance coverage and financial responsibilities to ensure transparency.
- Resolved insurance discrepancies, preventing billing errors and claim denials through proactive issue management.
- Accurately documents and updates patient records, including pre-certification numbers, eligibility details, and authorization statuses.
- Utilized electronic health record systems to maintain up-to-date patient data and documentation.
- Analyzed claims denials and implemented corrective actions, enhancing authorization success rates.
- Processed 30 to 40 insurance verifications daily.
Pharmacy Technician
Walgreens Pharmacy ( Part Time)
11.2021 - 12.2024
- Achieved objectives by preparing labels and filling prescriptions with pre-packaged common medications, enhancing order completion speed.
- Processed and dispensed medications accurately to ensure patient safety and compliance.
- Answered incoming phone calls, addressing inquiries from customers and healthcare providers to ensure clear communication.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Assisted customers with orders and navigation, resolving concerns to enhance service quality.
- 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.
- Utilize Aged Receivables Report as well as monitor outstanding insurance claims and actively follow up on pending payments, consistently reducing accounts receivable.
- Collaborated with patients to explain insurance coverage and payment options, which contributed to increased patient satisfaction and on-time payments.
- Facilitated communication between oral surgeons and patients, addressing conflicts and ensuring clarity in insurance matters.
- Managed patient insurance verification processes, ensuring accuracy and compliance with industry standards.
- Trained staff on insurance protocols and software usage, improving operational efficiency across the team.
- Assisted clients with understanding complex insurance policies, effectively addressing concerns or questions.
- Ensured timely verification of 30 insurance claims daily to enhance operational efficiency.
Medical Quality Assurance Specialist
OTC Management | Ajilon (Contract Position)
12.2021 - 02.2022
- Executed comprehensive reviews and audits of medical evaluation reports, ensuring adherence to company guidelines, industry standards, and government regulations.
- Served as subject matter expert on healthcare compliance, maintaining up-to-date knowledge of regulations and promoting adherence across the company.
- Collaborated with VA, providers, and claimants, placing outbound calls to provider offices to gather critical information, facilitating 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.
- Coordinated verification processes, ensuring timely and accurate management of patient data for improved compliance and operational effectiveness.
- Maintained compliance with healthcare regulations, including HIPAA, and consistently met or exceeded all quality assurance standards.
- Analyzed discrepancies in patient records and implemented corrective actions to maintain data integrity and support accurate billing.
- Assisted in retrieval and processing of insurance verification requests from local communities for outpatient, home health, or hospice services via inbound and outbound phone calls, enhancing overall workflow efficiency.
- Achieved a daily target of 40 verifications to enhance workflow efficiency.
Patient Service Representative
University Community Health Services
08.2015 - 10.2018
- Obtained and updated patient information in practice management system for established and new patients, ensuring accuracy and completeness.
- Scheduled patient appointments, verified insurance eligibility, and logged patient arrivals in Electronic Health Record (EHR) to maintain efficient patient flow.
Education
Diploma - Medical Billing and Coding
Ultimate Medical Academy
Clearwater High School Diploma -
Mcgavock High School
Nashville, TNSkills
- Insurance verification processes
- Patient Data Management
- Effective Communication
- Collaborative Teamwork
- Medical Terminology
- Insurance Cost Analysis
- Customer support
- HIPAA Compliance
- Scheduling and Appointment Management
- Prior authorization management
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
PSS coordinator
Trudata RX
09.2026 - Current
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 - 12.2025
Insurance Coordinator
OMS Nashville: Oral Surgery
07.2023 - 06.2024
Medical Quality Assurance Specialist
OTC 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
Diploma - Medical Billing and Coding
Ultimate Medical Academy
High School Diploma -
Mcgavock High School