Summary
Work History
Education
Skills
Timeline
Generic

Carol Brown

Manor,TX

Summary

Contract management professional with strong background in overseeing contract lifecycles, ensuring compliance, and mitigating risks. Skilled in negotiating terms, managing vendor relationships, and facilitating contract execution. Known for collaborating with teams, adapting to changing needs, and consistently delivering results. Proven ability to handle complex projects and maintain high standards in fast-paced environments.

Work History

Contract Specialist IV

Health & Human Services\Perk Performance Agency
08.2023 - 04.2024
  • Followed all company policies and procedures to deliver quality work.
  • Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
  • Collaborated with cross-functional teams to develop comprehensive contract strategies that met business objectives.
  • Examined records and business information for investment advisors to confirm adherence to government regulations.
  • Stored and filed contract documents in orderly, organized systems.
  • HHSC Medicaid Chip Services (MCS) AS Contract Specialist IV work on HIGH PRIORITY ASSIGMENTS.
  • Reports to the Health Plan Manager located in the Managed Care Contracts and Oversight (MCCO).
  • Maintained files and filing, keeping sensitive information confidential.
  • Collaborated with cross-functional teams to achieve project goals on time and within budget.
  • Liaised with outside organizations and financial management analysts to negotiate contract details.
  • Strengthened internal controls by developing and implementing contract management policies, procedures, and templates.
  • Ensured timely fulfillment of contractual requirements by closely monitoring progress and addressing potential issues proactively.
  • Supported company growth by consistently delivering successful contract outcomes that aligned with business goals.

Health Information Management Coordinator (PRN)

St. David's Medical Center
09.2022 - 04.2024
  • H.I.M. (Health Information Management) Retrieve/Reconcile medical records and loose documentation from ancillary departments, facilities, vendors, etc (ER-Emergency Room, IP-Inpatient Admit in the Hospital, SD-Same Day Procedure/Outpatient
  • Demonstrated expertise in organizing, filing, and retrieving patient records accurately and efficiently.
  • Assists Hospital Staff with requests for information on discharged and active patients.
  • Demonstrated strong organizational and time management skills while managing multiple projects.
  • Collaborated with interdisciplinary teams to establish best practices for maintaining accurate and timely medical records across the organization.
  • Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.
  • Maintained high levels of customer satisfaction by addressing concerns related to health information management promptly and professionally.
  • Effectively managed release of information requests, safeguarding patient privacy while adhering to legal requirements for disclosure purposes.
  • Spearheaded initiatives aimed at improving data integrity, implementing quality control measures throughout the life cycle of health information management processes.
  • Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
  • Improved interdepartmental communication by facilitating regular meetings between HIM team members and other departments.
  • Reduced errors in clinical documentation through targeted staff education initiatives on proper data entry techniques.

Public Assistance Eligibility Specialist

Texas Health & Human Services
09.2022 - 03.2023
  • Maintained a strong knowledge base of industry trends and changes to provide relevant information to clients.
  • Actively participated in community outreach projects, promoting our company''s commitment to social responsibility initiatives.
  • Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
  • Reviewed applications for different aid programs and determined which qualification criteria for individuals.
  • Assisted clients with accurate eligibility form, application and document completion.
  • Participated in cross-functional teams tasked with improving the overall effectiveness of public assistance programs through data analysis, policy revision, and process improvement recommendations.
  • Maintained up-to-date knowledge of federal, state, and local regulations governing public assistance programs to ensure compliance in all aspects of service delivery.
  • Collaborated with community partners to identify additional resources for clients in need, resulting in more comprehensive support services.
  • Streamlined the eligibility determination process by implementing case management best practices and accurate documentation.
  • Ensured data privacy compliance by adhering to strict confidentiality protocols when handling sensitive client information.
  • Improved client satisfaction with timely and thorough communication regarding their cases, including updates on application status.
  • Interviewed applicants and explained scope of different available benefits.

Provider Services Representative

Texas Department of State Health Services
03.2022 - 09.2022
  • Facilitated smoother claims processing by rigorously verifying provider information.
  • Streamlined process of provider credentialing, reducing waiting times significantly.
  • Served as a reliable resource for both internal staff and external partners, offering guidance on best practices in managing provider relationships.
  • Improved communication between providers and insurance companies, leading to better understanding of policy coverage and claim status.
  • Managed high call volume, providing prompt assistance to customers seeking help with their healthcare services.
  • Implemented effective problem-solving techniques, providing tailored solutions for individual customer concerns.
  • Enhanced customer satisfaction by efficiently addressing and resolving inquiries in a timely manner.
  • Facilitated effective communication between different departments involved in managing providers'' records, fostering a collaborative work atmosphere that enhanced productivity levels overall.
  • Managed multiple projects simultaneously while maintaining strict deadlines, showcasing exceptional organizational skills in fast-paced environments.
  • Collaborated with team members to share knowledge and develop best practices for customer support.
  • Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
  • Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.

Health Information Management Coordinator

St. David's Medical Center
09.2021 - 03.2022
  • Developed and implemented a comprehensive record retention policy, ensuring the proper storage and disposal of sensitive patient information.
  • Ensured compliance with HIPAA regulations by implementing strict privacy policies and confidentiality protocols for patient information.
  • Improved interdepartmental communication by facilitating regular meetings between HIM team members and other departments.
  • Evaluated new software solutions for potential implementation within the organization, leading to increased efficiency in managing health information systems.
  • Maintained knowledge of industry trends and best practices through continuous professional development opportunities, ensuring cutting-edge expertise in HIM processes.
  • Supervised a team of HIM professionals, providing guidance and support in achieving department goals and objectives.
  • Collaborated closely with physicians and nursing staff to improve quality of patient records documentation.
  • Assisted with the transition to electronic health records, ensuring a seamless integration process while maintaining data integrity.
  • Participated in committees to discuss electronic health records and methods to improve overall workflows.
  • Upheld HIPAA regulations and standards for protecting patient information.

Insurance Verification Specialist\Authorization

St David's Ambulatory Surgery Center
04.2020 - 08.2021
  • Answered telephone calls to offer office information, answer questions, and direct calls to staff.
  • Generated reports to track insurance verifications and claim progress.
  • Trained new staff on current, correct insurance verification procedures.
  • Complied with HIPAA guidelines and regulations for confidential patient data.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Maintained consistent follow-up on status of prior authorization requests.
  • Facilitated timely renewals of ongoing authorizations by closely monitoring expiration dates and initiating renewal processes proactively.
  • Improved patient care by efficiently coordinating authorizations for medical procedures and treatment plans.
  • Provided exceptional customer service to patients, addressing their concerns related to insurance coverage and authorizations promptly and empathetically.
  • Developed comprehensive training materials for new Authorization Coordinators, contributing to their successful onboarding process.
  • Maintained up-to-date knowledge of insurance policies, enabling accurate evaluation of coverage eligibility criteria for patients.
  • Acted as a resource for clinical staff, providing guidance on insurance requirements and authorization protocols.
  • Reduced errors in documentation submissions by performing meticulous quality checks before forwarding them to insurance companies.
  • Reviewed authorizations from payer to determine approved or denied items.
  • Contributed to the development of departmental policies and procedures relating to authorization management, promoting standardization across teams.
  • Coordinated seamless transitions of care for patients requiring referrals to specialty services, facilitating smooth handoffs between providers.
  • Reviewed documentation for accuracy and assessment of necessity.
  • Conducted thorough reviews of medical records to identify and address potential issues affecting authorization approvals.

Denial Specialist

St. David's Ambulatory Surgery Center
04.2018 - 04.2020
  • Collaborated with healthcare providers to ensure accurate and timely submission of claims.
  • Analyzed trends in claim denials, advising management on potential areas for process improvement.
  • Improved patient satisfaction by meticulously reviewing and appealing denied claims.
  • Liaised with insurance companies to negotiate settlements for complex or high dollar-value denied claims, securing maximum reimbursement possible for the organization.
  • Contributed to company-wide initiatives aimed at improving overall revenue cycle performance through targeted interventions addressing claim denials specifically.
  • Negotiated effectively with insurance carriers, securing rightful payments for complex denial cases.
  • Analyzed denial trends to proactively address recurring issues and improve clean claim submission rates.
  • Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
  • Documented medical claim actions by completing forms, reports, logs and records.
  • Streamlined communication between departments, facilitating faster resolution of denied claims.
  • Empowered team members with advanced tools for managing and appealing denials, increasing productivity.

Referral Specialist

St. David's Heart & Vascular
08.2016 - 04.2018
  • Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
  • Contributed to the development of referral policies and procedures, enhancing departmental operations.
  • Obtained prior authorization for [Type] procedures.
  • Collaborated with healthcare providers to ensure accurate and complete referral information, improving patient care coordination.
  • Promoted clear communication between primary care providers and specialists through detailed documentation and follow-up calls.
  • Enhanced patient satisfaction by promptly addressing inquiries and resolving issues related to referrals.
  • Communicated required insurance information in person and by telephone to patients, physician offices, third party payers and agencies.
  • Assisted in training new Authorization Representatives, sharing best practices to enhance overall team performance.
  • Enhanced overall department productivity by consistently meeting or exceeding monthly goals for completed authorizations.
  • Developed strong relationships with insurance companies, facilitating effective communication and increasing approval rates for authorizations.
  • Served as a knowledgeable resource for patients and healthcare providers on the nuances of various insurance policies, building trust and credibility in the role.
  • Streamlined the authorization process for faster response times and increased efficiency in the workplace.
  • Supported healthcare team members by providing detailed patient information for seamless transitions between providers.
  • Provided ongoing training for new Referral Specialist staff members, ensuring consistent quality service delivery across the team.
  • Managed high-volume referral requests by prioritizing tasks and maintaining organized records.

Registration Representative

St. David's Heart & Vascular
11.2015 - 08.2016
  • Determined appropriate appointment type and scheduled each in system.
  • Promoted a culture of continuous improvement by actively seeking feedback from patients regarding their registration experience and implementing changes as necessary.
  • Managed high-stress situations calmly while assisting patients experiencing medical emergencies or other urgent matters.
  • Served as a reliable resource for colleagues seeking assistance with complex cases or unfamiliar scenarios in the registration process.
  • Collaborated with cross-functional teams to improve departmental processes and ensure optimal workflow efficiency.
  • Coordinated with clinical departments to schedule appointments, confirm availability, and communicate any changes to patients.
  • Maintained accurate records by updating patient demographics, insurance, and financial information.
  • Supported hospital compliance efforts by adhering to HIPAA guidelines and maintaining the confidentiality of patient information.
  • Verified insurance benefits and obtained pre-authorizations before any medical procedures were performed.
  • Answered patient questions and inquiries regarding registration process and documentation.
  • Upheld HIPAA regulations and standards for protecting patient information.

Medical Office Specialist

St. David's Heart & Vascular
11.2014 - 11.2015
  • Received, recorded and filed medical payments by check, cash, and credit card.
  • Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
  • Used EPIC to schedule appointments for doctor visits and procedures.
  • Worked well in a team setting, providing support and guidance.
  • Self-motivated, with a strong sense of personal responsibility.
  • Ensured compliance with HIPAA regulations by strictly adhering to privacy protocols when handling sensitive patient information.
  • Supported office staff and operational requirements with administrative tasks.
  • Provided exceptional customer service, addressing patient concerns promptly and professionally.
  • Coordinated referral processes for specialist consultations or diagnostic tests requested by physicians.

Education

GED -

Johnston High School
Austin, TX
07-1995

Skills

  • Risk identification
  • Problem-solving
  • Excellent communication
  • Organizational skills
  • Strategic planning
  • Research and analysis
  • Workplace security
  • Time management
  • Multitasking
  • Attention to detail
  • Adaptability and flexibility
  • Active listening
  • Effective communication
  • Confidential records
  • Teamwork and collaboration
  • Skilled negotiator
  • Procurement strategies
  • Sanitation practices
  • Quality assurance
  • Self motivation
  • Decision-making
  • Superior client relations

Timeline

Contract Specialist IV

Health & Human Services\Perk Performance Agency
08.2023 - 04.2024

Health Information Management Coordinator (PRN)

St. David's Medical Center
09.2022 - 04.2024

Public Assistance Eligibility Specialist

Texas Health & Human Services
09.2022 - 03.2023

Provider Services Representative

Texas Department of State Health Services
03.2022 - 09.2022

Health Information Management Coordinator

St. David's Medical Center
09.2021 - 03.2022

Insurance Verification Specialist\Authorization

St David's Ambulatory Surgery Center
04.2020 - 08.2021

Denial Specialist

St. David's Ambulatory Surgery Center
04.2018 - 04.2020

Referral Specialist

St. David's Heart & Vascular
08.2016 - 04.2018

Registration Representative

St. David's Heart & Vascular
11.2015 - 08.2016

Medical Office Specialist

St. David's Heart & Vascular
11.2014 - 11.2015

GED -

Johnston High School

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Carol Brown