Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Brittany Flippin

McComb,MS

Summary

Highly motivated Claims Adjuster with excellent planning and problem- solving abilities and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in a fast-paced environment. Detail-oriented with a passion for providing exceptional customer service.

Overview

12
12
years of professional experience

Work History

Claims Adjuster

State Farm
12.2023 - Current
  • Manages case load of weather-related claims
  • Complete full investigation to determine coverages.
  • Evaluates pending claims to identify and resolve problems keeping the claim from moving forward
  • Review administrative standards whenever questions arise during processing of claims.
  • Comply with confidentiality regulations in handling customer information.
  • Issue payments
  • Maintain communication via phone and emails
  • Document claim file notes clearly and concisely in ECS
  • Correspond with insurance customers and agents to obtain or relay information on account status changes.
  • Compose business correspondence
  • Collaboration with fellow team members to manage large volume of claims.
  • Stay current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
  • Completed First Report of Injury form
  • Contacted employer for initial investigation
  • Contacted employee/injured worker for information - recorded statement


Contract Management & Build Specialist

Medix/Medhost
12.2022 - 12.2023
  • · Interpret hospitals' payor reimbursement contracts and payment terms for hospital services provided. Review, create, and upload fee schedules
  • · Build and maintain contract management master files including most recent rates, contracts, and other pertinent information to identify payor reimbursement discrepancies as determined from the terms of the payor contracts.
  • · Notify clients of any identified documentation needed to correctly maintain the contract terms based on any addendums or rate updates.
  • Continuously research, monitor, and implement payor regulated guidelines related to contract management
  • Identify incorrect charges on invoices by comparing them against contracts and fee schedules
  • · Ensure the database contract template accurately calculates the terms of the contract as written by validating results on accounts.


Provider Contract & Pricing Specialist

Wellpath/Healthcost Solutions
07.2019 - 12.2022
  • · Updated pricing software to properly calculate provider direct contracts based agreed terms
  • · Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
  • · Reviewed insurance policies to determine coverage and eligibility for claims processing. Research and review fee schedules as needed
  • · Documented file notes clearly and concisely in system.
  • Processed a high volume of claims on a daily basis
  • · Based payment or denials of medical claims upon well-established criteria for claims processing.
  • · Determined and calculated how each service line item should/shouldn’t be reimbursed/ Stop loss

Surgery Scheduler

Advanced Foot And Ankle
12.2018 - 07.2019
  • Maintained strict confidentiality in handling sensitive patient information, adhering to HIPAA guidelines and clinic policies.
  • Coordinated surgical team schedules for seamless procedure planning and execution.
  • Utilized advanced software tools to optimize appointment availability and efficiently manage surgeon calendars.
  • Elevated patient experience by providing empathetic support throughout the entire surgical journey-from initial consultation to post-operative follow-up appointments.
  • Handled urgent requests effectively, prioritizing cases requiring immediate attention while also balancing routine surgery demands appropriately.
  • Educated patients on pre-surgery requirements, such as fasting protocols or medication adjustments, resulting in fewer complications on the day of the procedure.
  • Acted as a liaison between patients, insurance carriers, and the surgical team to secure necessary authorizations for timely procedures.
  • Maintained accurate records for billing purposes, ensuring proper reimbursement from insurance carriers and patients alike.
  • Reduced surgery cancellations with thorough pre-operative assessments and communication with patients.
  • Verified insurance coverage and obtained pre-authorizations.
  • Arranged pre-operative and post-operative appointments for surgical patients.
  • Took pre-operative orders from surgeons and anesthesiologists for smooth operation planning.
  • Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.

Medical Billing & Coding Team Lead

Comprehensive Pain Specialists
03.2012 - 11.2018
  • Stay current on HIPAA regulations, medical terminology, procedure and diagnosis coding
  • · Audited high dollar claims.
  • Implemented process improvements that led to reduced turnaround times for critical tasks without compromising quality.
  • Trained new team members by relaying information on company procedures and safety requirements.
  • Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities.
  • Conducted regular progress reviews with individual team members to identify areas for improvement and provide guidance on career development opportunities.
  • Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
  • · Assigned correct diagnosis, procedures codes, and modifiers
  • · Ensured that all services documented in the procedure report were coded appropriately
  • Ensured all claim notes were thoroughly documented
  • · Maintained a 7 day or less turnaround time for all encounters to be coded and submitted to insurance

Education

Associate of Science - Medical Billing & Coding

Daymar College
Bowling Green, KY United States
09.2012

Skills

  • Verbal and Written Communication
  • Problem-Solving
  • Insurance Claims Management
  • Microsoft Office Suite/Teams/Zoom
  • Customer Service
  • Medical Terminology/ICD-9/ICD-10

Accomplishments

Florida - All Lines Adjuster

Texas - All Lines Adjuster

Louisiana - Crop, P&C, and Worker's Comp

Oklahoma - P&C

North Carolina - P&C

South Carolina - P&C

Kentucky P&C

Timeline

Claims Adjuster

State Farm
12.2023 - Current

Contract Management & Build Specialist

Medix/Medhost
12.2022 - 12.2023

Provider Contract & Pricing Specialist

Wellpath/Healthcost Solutions
07.2019 - 12.2022

Surgery Scheduler

Advanced Foot And Ankle
12.2018 - 07.2019

Medical Billing & Coding Team Lead

Comprehensive Pain Specialists
03.2012 - 11.2018

Associate of Science - Medical Billing & Coding

Daymar College

Similar Profiles

CREATE PROFILE
Brittany Flippin