Brittany Roberts
Auburn,GA
Summary
Results-driven Manager with extensive healthcare experience in process and benefits implementation for Medicaid, Marketplace, and DSNP plans. Expertise in problem-solving and regulatory compliance, leading to successful project completions. Proven ability to evaluate employee performance and resolve over 98% of trending provider issues through effective claims analysis.
Overview
14
14
years of professional experience
Work History
Manager-GA Payment Cycle and Operations
CareSource
08.2024 - Current
- Identify configuration priorities to ensure compliance with benefit, pricing, and regulatory requirements.
- Support large-scale projects on Medicaid, Marketplace, and DSNP benefit design implementations.
- Foster collaboration between departments to enhance operational efficiency.
- Hire and lead a team of 10 employees, providing coaching for high productivity.
- Analyze business performance data and forecasted outcomes for upper management.
- Conduct proactive analysis of claim payment trends, resolving issues efficiently.
- Ensure compliance with relevant laws and standards while overseeing regulatory tasks.
- Manage payment escalations effectively within Georgia market to address client concerns.
- Facilitate and manage provider/payer meetings regarding claims payment trends, resolving 98% of provider issues, timely and accurately.
Team Leader- GA Payment Cycle
CareSource
02.2022 - Current
- Provided analytical support and leadership for special reimbursement initiatives.
- Developed business requirements for payment decisions, managing implementation with stakeholders.
- Conducted systemic audits to identify reimbursement errors and recommend process changes.
- Led a team of analysts in payment cycle activities and issue resolution.
- Reviewed regulatory items to ensure alignment with business requirements.
- Validated Impact Reports and Mass Claim Adjustments for accuracy in reprocessing.
- Maintained collaborative relationships across multiple corporate areas.
Member Benefits Analyst III- GA Payment Cycle
CareSource
Atlanta, GA
01.2021 - 02.2022
- Ensured compliance with state guidelines and CMS regulations through claims configuration expertise.
- Directed annual updates of member benefits, collaborating with product leads for accuracy.
- Conducted audits to ensure adherence to internal guidelines and regulatory standards.
- Collaborated with configuration teams to define system requirements for member benefits.
- Validated UAT testing before production implementation, confirming all requirements were met.
- Facilitated strategic discussions with business owners to optimize benefit design solutions.
- Maintained comprehensive knowledge of member benefits in relation to state and federal regulations, including mental health parity, VFC, EPSDT, and DBHDD.
Analyst- Provider IVR and Benefit Store
Blue Cross Blue Shield of Michigan
Detroit, MI
04.2015 - 12.2021
- Analyzed and interpreted contract benefits from various corporate source documents in order to code new products, new groups, and group-wide changes into the Benefit Store.
- Detected, detailed, and resolved code delivery gaps between Common Services and the Benefit Store via internal reporting.
- Conducted research as required to resolve inquiries from internal and external customers on the Provider IVR and Benefit Store, communicating an appropriate and prompt response detailing the outcome of each inquiry.
- Served as a representative for the PIBS department in corporate workgroups for New Group Implementations, Group-Wide Changes, and Health Care Reform.
- Provided support on corporate SBT projects.
- Proactively identified and recommended departmental enhancements based on corporate, divisional, and departmental objectives.
- Participated in user acceptance and regression testing, including nights, weekends, and holidays.
- Initiated the creation of benefit codes, legends, and Limit and Override codes by submitting a change control request to the IT area.
Customer Service Representative II – Medicare Advantage Servicing
Blue Cross Blue Shield of Michigan
Detroit, MI
03.2012 - 04.2015
- I used Ika to assist and inform providers and members on claims adjudication processes and benefits information in a call center environment, averaging 80 to 100 calls per day.
- Troubleshoot claims information for providers with improperly processed claims, or missing payments.
- Educated members on their insurance coverage through BCBSM, focusing on first call resolution (FCR) through a service mentor and an 8-step call strategy.
- Communicated directly with BCBSM provider consultants to resolve complex inquiries.
- Worked with the leadership team and analysts to complete special projects and inquiries from other business areas.
- Encompassed a clear knowledge and comprehension of the Center for Medicare and Medicaid Services (CMS), and familiarity with the guidelines and processes that regulate Medicare Advantage.
- Identified processes that could be handled more effectively and efficiently, and assisted in developing new processes.
- I mentored my peers and new hire classes on lowering their actual call handling time and claim analysis.
Education
Bachelor of Arts - English, Sociology
Bowling Green State University
Bowling Green, OH08.2010
Skills
- SQL and database management
- Google Workspace proficiency
- Microsoft Office suite
- Effective communication
- Leadership and team management
- Analytical problem-solving
- Healthcare expertise
- Self-motivation
- Results-oriented mindset
- Claims analysis
- Operational efficiency
- Analytical thinking
- Staff development
Timeline
Manager-GA Payment Cycle and Operations
CareSource
08.2024 - Current
Team Leader- GA Payment Cycle
CareSource
02.2022 - Current
Member Benefits Analyst III- GA Payment Cycle
CareSource
01.2021 - 02.2022
Analyst- Provider IVR and Benefit Store
Blue Cross Blue Shield of Michigan
04.2015 - 12.2021
Customer Service Representative II – Medicare Advantage Servicing
Blue Cross Blue Shield of Michigan
03.2012 - 04.2015
Bachelor of Arts - English, Sociology
Bowling Green State University