Dominique Brown
Dallas,TX
Summary
Results-driven professional with a versatile background encompassing credentialing, IT support, compliance, and fraud intake. Proven expertise in streamlining and enhancing operational efficiency through the implementation of ITIL4 principles. Adept at navigating complex regulatory landscapes and ensuring strict adherence to compliance regulations. Excels in the management of diverse responsibilities, from intricate credentialing processes to resolving complex fraud cases. Eager to leverage extensive experience to contribute to an organization's success by integrating ITIL4 methodologies and maintaining compliance excellence.
Overview
9
9
years of professional experience
Work History
Technical Support Specialist (Contract)
NCR
Frisco, TX (Hybrid)
07.2023 - 01.2024
- Resolved complex technical issues related to Electronic Commerce solutions, collaborating with internal units and third-party vendors.
- Supported multiple product lines across industries, including Communications, Retail, and Finance, within the service delivery organization.
- Utilized Service Now for prompt response to customer inquiries, documented incidents, and contributed to process redefinition recommendations.
- Coordinated resources for problem resolution, assessed risks, evaluated supplier performance, and participated in pre-sales activities.
- Managed global scope projects, coordinating resources and ensuring adherence to timelines.
IT Support Specialist (Contract)
Cardinal Health
Lewisville, TX (Remote)
03.2022 - 02.2023
- Enhanced IT system stability by implementing proactive maintenance routines and monitoring tools.
- Administered AD on-premises and in Azure, with expertise in remote connection technologies (VPN, RDP, VDI) along with Microsoft Windows OS, Microsoft Office 365, and Apple iOS troubleshooting experience.
- Utilized system patching and updating, along with experience in communication software (WebEx, MS Teams) and mobile device management.
- Adhered to corporate compliance, guidelines, and policies; with willingness to support client systems after normal business hours when needed.
- Performed cross-training across departmental areas; responsible for user-friendly technical and desktop support, asset management, and system analysis.
Medicare Credentialing Specialist (Contract)
Cigna Health
Plano, TX (Remote)
09.2020 - 01.2022
- Led comprehensive credentialing processes, managing initial and recredentialing activities for providers and clinical teams nationwide.
- Contributed to internal and external audit preparation, ensuring compliance with regulatory requirements (e.g., CMS, DSHS, NCQA, JCAHO, DNV) and actively participated in the development of credentialing processes.
- Interacted with federal, state, and local agencies, hospitals, review boards, and malpractice carriers to obtain crucial provider information.
- Verified sensitive provider data through confidential sources, ensuring compliance document maintenance in designated systems.
- Assessed and interpreted application information, identifying areas of non-compliance and recommending corrective actions while facilitating effective communication between multiple parties, meeting policy timelines, and updating credentialing databases; providing status reports to internal and external stakeholders.
Healthcare Claims Analyst (Contract)
NTT Data
Plano, TX (Remote)
12.2018 - 03.2019
- Processed and adjudicated medical, dental, vision, and mental health claims, meeting and exceeding qualitative and quantitative production standards.
- Proficient claims examiner/adjudication experience in a computerized healthcare claims payment system (QNXT), with proficiency in CPT and ICD-9 coding, COBRA, HIPAA, pre-existing conditions, and coordination of benefits.
- Reviewed and recovered claims overpayments, ensuring accurate financial histories for patients and service providers.
- Managed investigation and overpayment administration, negotiating settlements, interpreting medical records, and resolving Department of Insurance complaints.
- Conducted claims research, including verification of medical necessities and coverage under policy guidelines.
Health Claims Analyst
Allegiance Benefit Plan Management
Plano, TX (Remote)
07.2018 - 12.2018
- Ensured timely and accurate adjudication of 90-110 medical, dental, vision, and prescription drug claims per day.
- Assigned critically ill patients to case management while assisting the case manager with direct negotiation and the efficient use of benefits.
- Researched, calculated, and requested refund when necessary while processing denials and appeals leading to 98% accuracy of processed claims.
- Updated and maintained patient records with accurate and current information including changes in primary/secondary/Tricare coverage, personal details, and contact information.
- Validated denial reasons and ensured coding reflected accurate denial reasons. Followed payer guidelines for appeals submissions.
Customer Service Representative (Contract)
AmerisourceBergen
Lewisville, TX (Remote)
01.2017 - 07.2017
- Handled 60-80 calls per day with strong customer service, interpersonal, and decision making skills.
- Processed prescription drug orders using the NDC, material drug number, or manufacturing information by phone, fax, and email for hospitals, pharmacies, and acute care facilities.
- Used SAP/CRM, Microsoft Teams, Microsoft Excel, and Salesforce to conduct daily tasks.
- Maintained PHI and HIPAA compliance while verifying patient information.
- Contributed to increased sales revenue by offering relevant product recommendations based on customer needs.
Fraud Intake / Customer Service Specialist
AdvoCare
Richardson, TX
08.2014 - 10.2016
- Handled a high volume of incoming calls, chats, and emails, regarding enrollments, payments, order tracking, and distributor agreements.
- Reviewed distributor agreements that were mailed, emailed, faxed, to ensure proper signature, dates, and notary standards were met.
- Leveraged sales expertise to promote products and capitalize on upsell opportunities which resulted in converting customers to distributors at an increased conversion rate of 66%.
- Implemented and adhered to Payment Card Industry Data Security Standard (PCI-DSS) guidelines in the capacity of a Fraud Intake Specialist, ensuring secure handling and processing of payment card information in compliance with industry standards
- Prepared working files, reported fraud accounts, and logged/tracked provisional credits while maintaining GL balances.
Education
Bachelor of Science - Health Informatics
University of North Texas
Denton, TX2023
High School Diploma
Ridgeway High School
Memphis, TN2009
Skills
- Desktop Component Repair
- Performance Optimization
- Customer Experience Management
- Hardware Upgrades
- ITIL 4
- Microsoft Office
- PCI-DSS
- Medical Terminology
- CompTIA Network
- HIPAA/ PHI
- Accredible-Credentialing
- ServiceNow/Salesforce
Timeline
Technical Support Specialist (Contract)
NCR
07.2023 - 01.2024
IT Support Specialist (Contract)
Cardinal Health
03.2022 - 02.2023
Medicare Credentialing Specialist (Contract)
Cigna Health
09.2020 - 01.2022
Healthcare Claims Analyst (Contract)
NTT Data
12.2018 - 03.2019
Health Claims Analyst
Allegiance Benefit Plan Management
07.2018 - 12.2018
Customer Service Representative (Contract)
AmerisourceBergen
01.2017 - 07.2017
Fraud Intake / Customer Service Specialist
AdvoCare
08.2014 - 10.2016
Bachelor of Science - Health Informatics
University of North Texas
High School Diploma
Ridgeway High School