Brittany Garfield
Coppell
Summary
Dedicated healthcare claims professional with expertise in denial management and compliance. Analyzes denial trends to implement effective appeals processes, enhancing payment resolutions. Strong communication and organizational skills facilitate efficient management of high-volume claims.
Overview
18
18
years of professional experience
1
1
Certification
Work History
MSRDP Clinical Denial Specialist II
Ut Southwestern Medical Center
Dallas
06.2024 - Current
- Reviewed denied claims for accuracy and completeness.
- Analyzed denial trends to identify patterns and root causes, informing targeted resolution strategies.
- Communicated with insurance representatives to clarify denial reasons.
- Documented resolution steps for denied claims in the system.
- Implemented appeals processes for challenging denied claims effectively.
- Maintained up-to-date knowledge of insurance regulations and policies.
- Analyzed and interpreted policy language, medical records, and other relevant data to identify coverage issues.
- Developed strategies to address complex denial issues, enhancing overall claims processing accuracy.
- Identified discrepancies in patient information, provider information, or coding accuracy during the denial process.
- Monitored assigned accounts for payment resolution or appeal opportunities.
- Reviewed and evaluated claims to determine if they meet the insurance criteria for reimbursement.
- Investigated and documented payment errors resulting from incorrect processing of claims.
- Participated in internal audits of departmental processes that impact revenue cycle operations.
- Compiled data from multiple sources into meaningful summary reports for management review.
- Responded promptly to customer inquiries about claim status or denied services.
- Ensured compliance with healthcare regulations and insurance policies during the denial management process.
- Maintained accurate records of all denied claims, appeals, and outcomes for reporting and analysis.
- Utilized critical thinking skills to evaluate denial patterns and recommend process improvements.
- Conducted detailed research on complex denial cases to determine the root cause and appropriate appeal strategy.
- Monitored claim denial trends to pinpoint process improvement opportunities and tailored training initiatives.
- Prepared and submitted appeal letters and necessary documentation to overturn unjustified denials.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
Financial and Claims Specialist
Expert Surgical
Frisco
07.2021 - Current
- Ensured documentation compliance with regulatory standards to support audit readiness
- Ensures supporting documentation is provided to corresponding insurance company facilitating timely payment on surgery claims
- Processed denied and rejected claims for each physician, filing appeals and reconsiderations to maximize reimbursement
- Reviews all claims for correct CPT and ICD10 coding
- Runs weekly reports of unpaid claims and ensures accurate reconciliation
- Defined collection process for copays, deductibles, out-of-pockets, and balances for upcoming appointments and surgeries to enhance patient payment clarity
- Discusses financial responsibility in-office with surgery patients
Medical Receptionist
Promenade Family Medicine
Richardson
10.2017 - 05.2019
- Handled incoming calls with professionalism, facilitating effective communication
- Verified and obtained insurance for all appointments, ensuring patient eligibility
- Coordinated schedules for doctor and nurses, ensuring timely patient appointments
IT Manager
North Oak Regional Medical Center
Senatobia
08.2015 - 08.2016
- Recovered $350,000 in missing claims
- Implemented HI IR system and transitioned practice to paperless operations, enhancing data accessibility
- Trained staff, including doctors and nurses, on HIIR system to ensure smooth adoption and usage
- Converted paper charts into electronic files, improving documentation accuracy and retrieval speed
- Maintained 24/7 on-call support during the conversion to the new system
- Compiled a detailed inventory of all hospital computers, tracking their locations and status.
Schedule/IT Manager
Barker Bariatric Center
02.2011 - 03.2015
- Managed IT infrastructure to support patient care and operational efficiency.
- Developed IT policies to ensure data security and compliance standards.
- Supervised technical support team to resolve user issues promptly.
- Trained surgeons, nurses and staff on EIIR system, enhancing team proficiency and support for patient care
- Scheduled new patients and guided them through bariatric surgery process, ensuring clear understanding of procedures and requirements
Special Events/Tour Intern
Houston Astros Baseball Club
07.2008 - 01.2009
- Scheduled, managed, and implemented events at Minute Maid Park, integrating TEKS-based learning for educational tours to enhance visitor experience.
- Lead all tours through Minute Maid Park for large corporations, all school districts in the Houston area, and all other private parties
- Increased revenue for the department with upgrade sales options for different events
- Developed marketing ideas for the Club, increasing visibility and attracting new members.
- Coordinated and led monthly support groups for post-bariatric patients, fostering community engagement and peer support.
- Designed, published and sent monthly newsletters
- Managed daily schedule for all doctors and surgeons
- Managed Southlake satellite office operations, including clinic scheduling, opening, and closing.
- Received referrals/inquiries and contacted the potential patient
Education
Communications - Sports Journalism
Texas State University
San Marcos, TX12-2011
Brookhaven College
Farmers Branch, TX03-2006
Skills
- Claims investigation
- Claims analysis
- Denial management
- Claims processing
- Claim adjustment
- Claim adjudication
- Appeals processing
- Claims documentation
- Claims preparation
- Claim resolution
- Insurance verification
- Insurance coverage verification
- Insurance plan verification
- Policy requirements and eligibility
- Policy modifications
- Commercial insurance
- Medicaid
- Utilization review
- Financial analysis
- Cost analysis
- Claims adjustment
- Claim amount calculations
- Documentation
- Documentation processing
- Billing software
- Insurance software
- Secure data practices
- Data entry
- Attention to Detail
- Critical problem-solving
- Problem-solving abilities
- Critical thinking
- Analytical thinking
- Negotiation tactics
- Reporting
- Task prioritization
- Work prioritization
- Multi-tasking
- Form preparation
- Collaborative relationships
- Active listening
- Interpersonal skills
- Communication skills
- Adaptability
- Background in insurance
- Medical terminology
- Insurance terminology
- Industry trends
- Goal setting
- Computer proficiency
- Administrative support
- Skilled in Epic
- Documentation
- Claims adjustment
- Insurance terminology
- Administrative support
- Skilled in Epic
Certification
Notary Public
Timeline
MSRDP Clinical Denial Specialist II
Ut Southwestern Medical Center
06.2024 - Current
Financial and Claims Specialist
Expert Surgical
07.2021 - Current
Medical Receptionist
Promenade Family Medicine
10.2017 - 05.2019
IT Manager
North Oak Regional Medical Center
08.2015 - 08.2016
Schedule/IT Manager
Barker Bariatric Center
02.2011 - 03.2015
Special Events/Tour Intern
Houston Astros Baseball Club
07.2008 - 01.2009
Communications - Sports Journalism
Texas State University
Brookhaven College