Summary
Overview
Work History
Education
Skills
Certification
Volunteer Experience
Accomplishments
References
Timeline
Generic

Brittanie Williams

San Tan Valley,AZ

Summary

Military Spouse and an experienced healthcare insurance professional with over 10-years of experience. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Detail-oriented, observant and knowledgeable with excellent interpersonal and documentation skills. Efficiently handle high case volumes with accuracy and care.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Data Mining Appeals Analyst

United Healthcare
09.2022 - Current
  • Performing comprehensive research when reviewing provider appeals or disputes on previously identified overpayments
  • Performed research, and analyze claims data, applying knowledge of medical reimbursement policies, analytics, or algorithms to determine validity of the overpayment in accordance with all applicable guidelines and policies
  • An expert level of familiarity and understanding of CMS guidelines and reimbursement policies
  • Facilitated platform level team calls with assistance from a mentor or SME
  • Attended meetings with management staff concerning policy changes impacting the appeals process.

Senior Appeals Representative

United Healthcare
06.2021 - 09.2022
  • Read and understand information from patient medical records, claims history and DOL / State regulations
  • Review patient files and utilize knowledge and skills of payer requirements to determine if medical claims are adjudicated correctly
  • Maintain daily assignments while complying with the due dates per company policy and the state regulations.
  • Reviewed, investigated, and completed the resolution of Provider Disputes in writing
  • Developed procedures for tracking appeal requests and processing outcomes.

Senior Clinical Administrative Coordinator

United Healthcare
09.2016 - 06.2021
  • Maintained records of patient care plans, medical histories and test results in compliance with HIPAA regulations.
  • Coordinated with physicians, nurses, staff and other healthcare professionals to ensure quality patient care.
  • Reviewed incoming referrals for accuracy prior to processing them into the system.
  • Provided support during audits conducted by external regulatory agencies.
  • Served as a liaison between different departments in order to facilitate communication.
  • Interviewed applicants and made recommendations for new hires.
  • Improve policies and procedures through development, implementation, revision and evaluation of new protocols.

Lead Provider Resolution Specialist

United Healthcare
08.2015 - 09.2016
  • Developed relationships with customers through effective communication and problem solving skills.
  • Documented all interactions with customers in the company database system.
  • Conducted training sessions on provider resolution processes for new employees.
  • Analyzed data collected from surveys or other methods to determine areas of improvement.
  • Responded promptly to emails or phone calls related to provider resolutions.
  • Increased customer satisfaction ratings 15% by effectively answering questions, suggesting effective solutions and resolving issues quickly.

Health Concierge Team Lead

Aetna
10.2014 - 08.2015
  • Facilitated communication between patients, providers, and insurance companies.
  • Managed over 75 health plan-related calls in fast-paced call center environment.
  • Assisted in the coordination of patient referrals for specialist services.
  • Compiled and analyzed data from various sources to generate reports related to health trends among clients.
  • Researched and corrected customer issues in areas such as plan benefits, coverage eligibility and claims processes.
  • Evaluated performance metrics from existing processes to recommend improvements in product quality.

Military Service Representative

United Healthcare
10.2013 - 10.2014
  • Provided administrative support to military personnel and their families.
  • Performed data entry into automated systems to update personnel information.
  • Verified eligibility criteria for accessing a variety of programs offered by the military.
  • Collected deposits or payments and arranged for billing.
  • Maintained sensitive records, including medical and financial documents.

Education

High School Diploma -

Lee M. Thurston High School

Some College (No Degree) - Medical Insurance Billing

DeVry University
Downers Grove, IL

Skills

  • Claims Processing & Evaluation
  • Decision-Making
  • Relationship Building & Team Collaboration
  • File and Record Management
  • Critical Thinking
  • Benefit Explanation
  • Database Management
  • Coaching and Mentoring
  • Sourcing and Compiling Information
  • Policy Analysis & Writing
  • Fraud Identification
  • Regulatory Compliance
  • Computer Skills
  • Microsoft Office Suite
  • Customer Service and Support

Certification

  • CPR
  • Level 1 Fingerprint Clearance Card

Volunteer Experience

  • NAACP Youth Program
  • UnitedHealth Group, Compassion Committee
  • Parent School Volunteer

Accomplishments

  • Dean's List
  • Leadership of the Year 2021

References

References available upon request.

Timeline

Data Mining Appeals Analyst

United Healthcare
09.2022 - Current

Senior Appeals Representative

United Healthcare
06.2021 - 09.2022

Senior Clinical Administrative Coordinator

United Healthcare
09.2016 - 06.2021

Lead Provider Resolution Specialist

United Healthcare
08.2015 - 09.2016

Health Concierge Team Lead

Aetna
10.2014 - 08.2015

Military Service Representative

United Healthcare
10.2013 - 10.2014

High School Diploma -

Lee M. Thurston High School

Some College (No Degree) - Medical Insurance Billing

DeVry University

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