BRITTANY DAVIS
Lakeland,FL
Summary
Experienced Claims Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem solving abilities. Offering 10+ years of experience and willingness to take on any challenge. Organized and dependable candidate with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
14
14
years of professional experience
Work History
Senior Quality/Auditor
UnitedHealth Group
Miami, FL
06.2016 - Current
- Thoroughly review, analyze, and investigate complex health care claims to identify discrepancies.
- Navigate across various computer systems to locate and gather critical information (CPA, Macess, Cosmos, Facets, Webstrat, Webtrax). Consistently meet established productivity, schedule adherence, and quality standards.
- Conduct audits and provide feedback to reduce errors, improve processes, and ensure quality and consistency.
- Prioritize and organize tasks to meet established productivity, schedule adherence, and quality standards.
- Research and interpret Medicare and Medicaid policies and regulations to properly process claims.
- Tracked quality metrics such as defect rate, rework rate, waste rate.
Claims Processor
Aetna
Plantation, FL
03.2013 - 06.2016
- Resolved complex claims issues associated with denied or underpaid claims through negotiation with payers.
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
- Analyzed and evaluated claim forms, medical reports, bills, and other documents to ensure accuracy of data.
- Identified trends in denials or rejections due to incorrect coding or billing practices by providers.
Pharmacy Technician
Walgreen's Pharmacy
Miami, FL
01.2011 - 03.2013
- Oversee inventory management processes such as ordering, stocking, tracking expiration dates.
- Order supplies and restocked shelves when necessary.
- Provide customer service to patients by answering questions related to prescriptions, insurance coverage.
- Work with insurance companies to process claims, resolve problems and obtain payments.
- Assist pharmacist with clearing high volume of prescriptions and responded to customer questions.
Education
High School Diploma -
Miami Northwestern Senior High School
Miami, FLBachelor of Science - Health Administration
University of Phoenix
Tempe, AZSkills
- HIPAA Compliance
- Model Audit Rule (MAR)
- CMS Compliance
- HEDIS
- Report Generation
- Adaptive Learning
- Data Validation
- Claims Review
- Interpersonal and Written Communication
- Data Privacy Initiatives
- Policy Investigations
- Claims Evaluation
- Claims Processing
- Team Leadership
- Expert proficiency in Microsoft Word, Excel
- Expert proficiency in Systems: Facets, ORS, NDB, EnterpiseNow, CPA, Cosmos, iCES, ICUE, PSI, EWD,
Timeline
Senior Quality/Auditor
UnitedHealth Group
06.2016 - Current
Claims Processor
Aetna
03.2013 - 06.2016
Pharmacy Technician
Walgreen's Pharmacy
01.2011 - 03.2013
High School Diploma -
Miami Northwestern Senior High School
Bachelor of Science - Health Administration
University of Phoenix