BRITTANY FLENORY

• Led the design and delivery of technical training programs for software developers, system administrators, and end-users

• Delivered on-site and remote technical training sessions for new product releases and updates.

• Spearheaded the retrospective sessions for the enhancement of technical training materials for onboarding and ongoing training for internal and external customers

• Collaborated with subject matter experts to stay updated on the latest industry trends and incorporate them into training programs

• Developed training materials, inclusive but not limited to: PowerPoint presentations, hand-on exercises, and job-aids, tailored to the needs of various skill levels

• Conducted technical product training for new releases for service employees

• Collaborated with product development teams to ensure accurate and up-to-date training materials

• Interpreted and configured client-specific business requirements in Content Manager for ClaimsXten solutions, ensuring accurate claims editing and alignment with client needs.
• Developed basic to advanced customized policies and implemented default and new claim editing rules within Change Healthcare KnowledgePack to meet client specifications.
• Led requirement gathering sessions, coordinated tasks, and managed day-to-day interactions with clients and cross-functional teams to streamline workflows and enhance solution delivery.
• Advised clients on best practices for ClaimsXten configurations and customizations, enhancing efficiency and accuracy.
• Conducted gap analysis and recommended process improvements, creating high-quality documentation to support team training and enable seamless system adoption.
• Supported product launches by defining requirements, conducting market analysis, and developing competitive positioning strategies.

• Led concept development/requirement gathering sessions with data analytics to identify fraud, waste, coding errors, and payment issues.
• Guided stakeholders on Prospective Payment Systems (PPS), including RUGS, HIPPS, RBRVS, APC, Grouper, and DRG.
• Developed cost-saving concepts for acute and post-acute care, focusing on recouping improper Medicare/Commercial payments.
• Analyzed healthcare claims data to create edits for post-acute care and hospice.
• Used SQL to query claims data, identifying trends and cost-saving opportunities.
• Communicated reimbursement methods and analysis findings in client meetings.
• Recommended policy changes to improve savings.
• Researched provider reimbursement rules for Commercial/Medicare/Medicaid.
• Presented insights to internal and external stakeholders.
• Collaborated with sales and management to deliver tailored solutions

• Identified and managed medical cost savings opportunities by analyzing healthcare data, utilizing SQL and Tableau to uncover trends, anomalies, and savings potential.
• Developed data abstraction criteria and presented new savings opportunities (edits) to clients for approval before production.
• Guided internal teams and clients in understanding provider reimbursement methodologies, including FFS, per diem, DRG, APC, and PPS.
• Conducted analytical and investigative work to support new concept development and optimize client claims data quality using advanced Excel and Facets.
• Promoted cross-pollination of concepts across Optum’s Payment Integrity portfolio and influenced client adoption of new approaches and products.
• Led virtual training sessions, providing technical direction to consultants and executive leadership.

• Lead Preceptor/Training responsibilities for newly hired data analysts
• Conducted audits of ACO physician data within claim platforms (Facets system) and provided feedback to reduce errors and improve provider contracting implementation
• Reported, extracted, and interpreted data from reporting tools (NDAR, UHN Reporting) for various types of analyses with Excel functions
• Assisted team members with understanding complex issues and problem solving related to network analysis, provider fee schedule, and network management
• Analyzed data retrieved from reports to determine performance gaps and key trends in provider demographics and claim data to optimize claim payment

• Lead claims platform auditing team in understanding the verbiage and technicality of provider Medicaid contracts to support accurate claim payments
• Created and documented audit workflow process
• Worked with cross functional teams to develop policies and procedures to promote better business processes
• Facilitated virtual meetings to discuss audit findings and root cause analysis
• Assisted team members with understanding and maneuvering through claim platforms to identify information needed for audit
• Analyzed data retrieved from reports to determine performance gaps and key trends in provider demographics and claim data to optimize claim payment
• Analyzed fee schedule loaded in NetworX Pricer to ensure rates and codes are consistent with executed agreement

• Managed physician contracting activities including value-based contracts and Medicare incentive agreements
• Negotiated with providers both in-person and virtually regarding proposed rates
• Established and maintained a viable network of medical providers for the state of Arkansas to ensure adequate specialty saturation
• Facilitated virtual meetings with internal departments as well as external vendors
• Lead training and assistance to providers with resolving reimbursement problems or unresolved claims
• Explained claim payment process and billing procedures as it related to contracted rates
• Educated providers and staff on coding, ICD-9 and billing best practices to promote clean claim submission and expedite claim payment
• Analyzed provider records in claims systems based on demographic and credential changes and submitted updates in a timely manner as needed

• Lead managed care team with interpretation of managed care reimbursement methodologies such as RBRVS, APCs, ASC groupers, per diems, MS-DRGs, fee schedules and case rates
• Analyzed and audited hospital facility claims data (outpatient and inpatient) to enforce contract agreement and payment variance resolution
• Interpreted managed care contract verbiage for appropriate contract loading for central business office
• Communicated with payer for understanding and resolution of incorrectly paid hospital facility claims
• Reviewed medical records for potential coding inaccuracies
• Assisted BMT team with global billing and package payment resolution
• Analyzed fee schedule and explanation of benefits to determine proper processing of charges
• Composed Appeal letters to recover unresolved Commercial Claims
• Medicaid, Managed Care & Medicare Escalated Claim Billing & Denial Resolution