Brittany Cherry
Roanoke,Virginia
Summary
Accomplish organizational improvements through leveraging expertise in billing, research, and system enhancement.
Overview
9
9
years of professional experience
Work History
Medical Management Specialist
Erie Insurance
- 12.2023
- Handles first party medical benefit claims, including fatalities and wage loss claims
- Manages caseload by conducting investigations, determining total value of claims and setting adequate reserves
- Prepares related correspondence and reports and calculates wage loss claims per applicable state laws to brings claims to conclusion
- Evaluates, process and make payments on medical bills and Medicare cases in order to meet regulatory obligations requirements
- When appropriate manages claims in litigation and assist in the development of case strategy with legal counsel.
Business Control Specialist
United Healthcare
10.2022 - 12.2023
- Responsible for ensuring accurate delivery of Medicare claims and controls within various contractual turnaround time
- Supported tracking of claims during specific processing stages including system errors and payment outcome
- Calculated and corrected payment and reimbursement rates on physician and hospital claims
- Audited and documented claim information and utilized it to improve process, quality and accuracy performance within CMS guidelines
- Completed projects assigned by management and track it against time management reports
- Met and exceeded efficiency, TAT, and accuracy resulting in over 100% scores every quarter.
Claims Rework Representative
United Healthcare
04.2019 - 10.2022
- Provided research to adjust and process payment to physician and hospital claims according to providers contracts and members benefits
- Audited claims by conducting investigation within providers’ credentials and billing trends
- Analyzed, identified, and documented claim trends that have been processed incorrectly by multiple processors
- Appointed as OJT and buddy for new hire processors
- Worked and collaborated with legal team to provide feedback on claims’ outcome
- Documented and communicated status of claims/investigation to Internal Business Partners
- Received and addressed escalated claims to resolve issues quickly.
Claims Representative Associate
United Healthcare
04.2018 - 03.2019
- Researched, identified, and collected data from HCFA form (such as place of service, CPT and diagnosis codes) needed to accurately process claims by verifying prior authorizations, benefits, and payment information
- Ensured provider meets credentialing standards for claims processing
- Resolved and addressed new or unusual claim errors
- Met and achieved performance metrics by consistently scoring above 100% goal
- Collaborated with internal departments and external vendors to achieve fast resolution of claims
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit providers' needs
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Court Record Research Specialist
Securitec Screening Solutions
05.2017 - 03.2018
- Performed criminal and civil court record check across 50 states using publicly available sources, interviews and internal software
- Conducted on-line, courthouse, and phone research activities to collect public data to contracted clients
- Ensured reports are accurate and met customer specified guidelines and turnaround time
- Appointed to train new employees and implemented short-term and long-term goals.
Medication Technician (Part time)
CCS Medical, Western Virginia Regional Jail
10.2015 - 03.2018
- Prepared and administered prescribed medications to over 50 patients while in compliance with all Facility policies and procedures and Pharmacy Board rules and regulations governing administration and documentation of medication
- Participated in data collection, medication audits, and other performance improvement activities related to pharmacy and medication
- Prepared medication doses accurately by following medication administration record (MAR) written by healthcare providers
- Recorded medication inventory routinely to maintain medication security and control
- Unpacked, sorted, counted, and labeled all incoming medications to keep optimum inventory levels
- Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care
- Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
Financial Crimes Specialist
Wells Fargo
11.2014 - 12.2015
- Conducted data and onsite reviews, reviewed findings, determined risk level, and recommended fraud prevention strategies
- Managed 40-50 customer calls per day for fraudulent activity
- Performed investigative research, root cause evaluation and consulting regarding complex financial crimes transactions, policy violations and suspicious situations with moderate to high risk
- Prepared documentation and referred cases for Suspicious Activity, Identity Theft Operations and Suspected Financial Abuse, reports to government agencies
- Adhered to federal and state bank and debit card regulations regarding account processing.
Education
Master of Arts - Law
Regent University
12.2023
Bachelor of Science - Criminal Justice
Ferrum College
05.2014
Skills
- HIPAA Compliance
- Healthcare Analytics
- Microsoft Office
- Insurance Verification
- Healthcare management
- Quality Improvement
State
Virginia
Zip
24012
City
Roanoke
Timeline
Business Control Specialist
United Healthcare
10.2022 - 12.2023
Claims Rework Representative
United Healthcare
04.2019 - 10.2022
Claims Representative Associate
United Healthcare
04.2018 - 03.2019
Court Record Research Specialist
Securitec Screening Solutions
05.2017 - 03.2018
Medication Technician (Part time)
CCS Medical, Western Virginia Regional Jail
10.2015 - 03.2018
Financial Crimes Specialist
Wells Fargo
11.2014 - 12.2015
Medical Management Specialist
Erie Insurance
- 12.2023
Master of Arts - Law
Regent University
Bachelor of Science - Criminal Justice
Ferrum College