DEBRINA CLAY
Starkville ,MS
Summary
Adaptable healthcare professional with 20+ years of experience improving patient care and organizational efficiency. Skilled in data accuracy, compliance, data management, workflow optimization, building strong relationships, and specializing in Health Information Management (HIM) and technology for 7+ years. Currently serving as a Provider Relations Associate Analyst at Evernorth Health Services, optimizing provider data management, resolving inquiries, and facilitating effective workflows for mental health and substance use disorder providers. Previous experience at UnitedHealthcare demonstrates a commitment to quality improvement through data integrity, analytics, claims processing, error resolution, and cross-department collaboration.
Overview
21
21
years of professional experience
Work History
Provider Relations Associate Analyst
Evernorth Health Services
04.2025 - Current
- As a contractor with ๐๐๐ข๐ฅ๐จ๐ซ๐๐ ๐๐๐ง๐๐ ๐๐ฆ๐๐ง๐ญ, on behalf of ๐๐ก๐ ๐๐ข๐ ๐ง๐ ๐๐ซ๐จ๐ฎ๐ฉ, resolve provider inquiries, information related to provider data and network operations, and streamline workflows to support effective communication with healthcare professionals within Evernorth Behavioral Healthcare.
- Ensure data accuracy and compliance with internal protocols in provider data management systems.
- Manage inbound calls from providers and support staff concerning mental health services.
- Aid in verifying eligibility and benefits, and address authorization requirements for providers.
- Assist in educating healthcare providers on network policies.
- Escalate complex questions when necessary.
Career Transition and Family Leave
Career Break
01.2025 - 04.2025
- Focused on personal mental health needs after experiencing a personal loss.
- Engaged in self-care and reflection to reassess career goals.
- Solidified passion for a career in health information management during the introspective period.
Associate Claims Representative
UnitedHealth Group | UnitedHealthcare
11.2022 - 01.2025
- Reviewed and processed health insurance claims efficiently by applying benefit levels per policy and adhering to company policies.
- Worked with internal teams to improve the resolution of complex claim issues.
- Reviewed claims data to uncover trends and propose strategies for operational efficiency.
Licensed Service Advocate
UnitedHealth Group | Optum
07.2020 - 11.2022
- Achieved full-time status following contract tenure with PeopleShare in December 2020.
- Conducted individualized needs assessments to guide Medicare Supplement and Prescription Drug Plans selection.
- Executed secure processing of PHI and PII following HIPAA and CMS guidelines.
- Utilized CRM software and relational databases to enhance data management and project coordination.
- Executed outbound calls to update members on plan benefits and enrollment status.
- Enhanced data management technology expertise through continuous learning.
Health and Well-being
Career Break
11.2018 - 06.2020
- Resolved health issue requiring corrective eye surgeries, enabling a successful return to the workforce.
- Prioritized health and well-being, accessing the Department of Rehabilitation Services vocational support.
- Gained valuable, transferable skills supporting professional development and relevance in the evolving healthcare sector.
Aon Retiree Health Exchange Benefits Advisor
Sitel
07.2019 - 12.2019
- Provided expertise in helping retirees navigate health, vision, and dental insurance selections.
- Performed needs assessments to assist Pre-Medicare beneficiaries in choosing appropriate insurance plans.
- Partnered with experts to improve client services and uphold Medicare standards.
- Guided participants in transitioning from employer group health plans to individual market plans, maintaining data accuracy.
Patient Service Representative
MedAssist, A Firstsource Company
06.2016 - 11.2018
- Performed thorough evaluations for uninsured and underinsured patients to enable access to medical coverage.
- Facilitated collaboration between hospital teams and government entities to improve compliance processes.
- Contributed to improved financial outcomes by enhancing revenue cycle management.
Professional Development
Career Break
01.2015 - 06.2017
- Developed skills in inventory management, problem-solving, teamwork, communication, and attention to detail in a fast-paced environment.
- Acquired enhanced skills and new perspectives in the position of Patient Services Representative at MedAssist.
Emergency Department Technician | Admissions Counselor
North Mississippi Health Services
11.2006 - 01.2015
- Advanced to full-time status in 2014 from a PRN role.
- Ensured smooth hospital operations through accurate patient data documentation.
- Collaborated with physicians and nursing staff to provide compassionate care for patients with acute and chronic conditions.
- Enhanced patient outcomes by performing essential assessments and emergency interventions.
- Executed ancillary procedures to enhance medical team support.
Recovery Audit Contractor (RAC) Coordinator
OCH Regional Medical Center
01.2011 - 01.2014
- Streamlined audit management by acting as communications liaison for Medicare Recovery Audit Contractors.
- Coordinated daily operations for RAC and Revenue Cycle teams, boosting departmental efficiency through proactive engagement.
- Documented audit findings while managing the 3M Health Data Management system to ensure compliance with audit response timelines.
Utilization Review Technician
OCH Regional Medical Center
08.2007 - 01.2011
- Analyzed healthcare services to ensure alignment with medical necessity requirements.
- Monitored patient records to ensure compliance with concurrent care standards.
- Collaborated with healthcare professionals to enhance clinical outcomes and optimize reimbursement from third-party payers.
Emergency Department Technician
OCH Regional Medical Center
02.2005 - 08.2007
- Assisted physicians and nursing staff in delivering compassionate care to patients with acute and chronic conditions.
- Implemented vital assessments and managed medical emergencies under supervision, ensuring optimal patient outcomes.
- Performed various ancillary procedures, including phlebotomy and wound care, enhancing the quality of care provided.
- Contributed to a collaborative medical team at OCH Regional Medical Center, improving patient satisfaction and care efficiency.
Patient Access Representative | Business Services
OCH Regional Medical Center
12.2004 - 02.2005
- Streamlined patient registration processes to enhance efficiency and reduce wait times.
- Coordinated insurance verification procedures to ensure accurate patient billing and coverage information.
- Collaborated with healthcare providers to resolve patient inquiries, enhancing overall service quality.
Education
Bachelor of Science - Interdisciplinary Studies
Mississippi State University
Starkville, MS05.2006
Skills
- Health Care HIPAA Counseling Consulting
- Data Management Data Analysis CRM Databases
- Utilization Management Insurance
- Operating Systems: Windows, iOS, Linux
- Health Information Management Technology
- Quality Assurance Special Projects Analytical Research
- Revenue Management Cycle & Billing
- Microsoft office
- Microsoft Excel
- Quantitative analysis
- Continuous improvement
- Attention to detail
- Time management
- Analytical problem solving
- Process improvements
- Database management
Languages
English
Native or Bilingual
Work Preference
Work Type
Full TimeContract WorkPart TimeWork Location
RemoteImportant To Me
Career advancementWork-life balanceCompany CultureFlexible work hoursPersonal development programsHealthcare benefitsWork from home optionTeam Building / Company RetreatsPaid time off401k matchTimeline
Provider Relations Associate Analyst
Evernorth Health Services
04.2025 - Current
Career Transition and Family Leave
Career Break
01.2025 - 04.2025
Associate Claims Representative
UnitedHealth Group | UnitedHealthcare
11.2022 - 01.2025
Licensed Service Advocate
UnitedHealth Group | Optum
07.2020 - 11.2022
Aon Retiree Health Exchange Benefits Advisor
Sitel
07.2019 - 12.2019
Health and Well-being
Career Break
11.2018 - 06.2020
Patient Service Representative
MedAssist, A Firstsource Company
06.2016 - 11.2018
Professional Development
Career Break
01.2015 - 06.2017
Recovery Audit Contractor (RAC) Coordinator
OCH Regional Medical Center
01.2011 - 01.2014
Utilization Review Technician
OCH Regional Medical Center
08.2007 - 01.2011
Emergency Department Technician | Admissions Counselor
North Mississippi Health Services
11.2006 - 01.2015
Emergency Department Technician
OCH Regional Medical Center
02.2005 - 08.2007
Patient Access Representative | Business Services
OCH Regional Medical Center
12.2004 - 02.2005
Bachelor of Science - Interdisciplinary Studies
Mississippi State University
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