Overview
Work History
Education
Skills
Timeline
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BRYAN STOUT

Florence,AZ

Overview

28
28
years of professional experience

Work History

PROVIDER DATA SPECIALIST

United Healthcare
Minnetonka, USA
03.2009 - Current
  • Company Overview: UHG, Minnetonka, MN
  • Researches and verifies provider records for correct claims payment for both par and non-par providers
  • Load non-par providers into NDB as needed for claims processing
  • Assists in the cleanup of the current provider information, including verifying and correcting demographical errors and adding missing information such as provider specialties
  • Resolves provider database issues such as addresses, user warnings, etc
  • And makes corrections as needed
  • Communicates effectively with other departments within the platform, other dept., and externally with UHC employees who require precise database information in order to ensure claims are paid correctly
  • Meets established productivity and quality standards with little or no supervision
  • Takes responsibility and ownership for assignments and projects in a timely and accurate manner
  • Performs other projects and duties as assigned
  • Works as a liaison to other departments that help in resolving provider issues.
  • Handle any escalated issues directed by supervisors from other areas related to claim demographics.
  • UHG, Minnetonka, MN
  • CSP Facets Experience, or other claims processing systems.
  • 1+ years of experience healthcare industry
  • 6 months or more of NDB Experience
  • Knowledge of medical terminology and managed health care.
  • Customer Service experience
  • Experience working with healthcare providers

CLAIMS PROCESSOR

Blue Cross Blue Shield of New Mexico
Alburquerque, USA
02.2007 - 01.2009
  • Company Overview: Alburquerque, NM
  • Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines
  • Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes
  • Verifies that claims have been keyed correctly
  • Ensures that claims are processing according to established quality and production standards
  • Corrects processing errors by reprocessing, adjusting, and/or recouping claims
  • Researches and resolves claims edits and deferrals
  • Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas
  • Responds to routine correspondence and completes spreadsheet if applicable
  • Alburquerque, NM
  • Organized information by using spreadsheets, databases or word processing applications.

CLAIMS SPECIALIST

Aflac Inc
Columbus, USA
04.1997 - 03.2006
  • Company Overview: Columbus, GA
  • Research reported claims and determine validity of the claim
  • Manage the documentation and submission process of each claim
  • Collect all necessary documents and information to file, investigate, and resolve claims in a timely manner
  • Columbus, GA

Education

MBA - Business Administration

UNIVERSITY OF GEORGIA
Athens, GA
06.1992

Skills

  • HIPAA compliance
  • Medicaid
  • Medicare
  • Database administration
  • Microsoft Excel
  • Credentialing processes
  • Provider relations
  • Data management
  • Multitasking
  • Team building
  • Teamwork and collaboration
  • Time management
  • Data loading
  • Teamwork
  • Attention to detail
  • Decision-making
  • Effective communication
  • Data security
  • Team collaboration
  • Interpersonal skills
  • Active listening
  • Adaptability and flexibility
  • Customer service
  • Problem-solving

Timeline

PROVIDER DATA SPECIALIST

United Healthcare
03.2009 - Current

CLAIMS PROCESSOR

Blue Cross Blue Shield of New Mexico
02.2007 - 01.2009

CLAIMS SPECIALIST

Aflac Inc
04.1997 - 03.2006

MBA - Business Administration

UNIVERSITY OF GEORGIA

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