Erica Broodie
Jacksonville,Florida
Summary
Compassionate Community Health Worker with 8 years of experience in fast-paced positions. Committed to helping community members improve wellness through hands-on support and education.
Overview
9
9
years of professional experience
Work History
Health Program Representative II
Elevance Health/Amerigroup
01.2023 - 08.2023
- Conducted claim reviews for members for determination of eligibility for the patient review coordination program for Amerigroup Washington State
- Complied with the Washington Administrative Code with matching criteria based on claims or office & ER visits
- Assisted with documenting critical incidents & death reports located in the SharePoint drive through the company’s intranet page
- Kept organization of members within the PRC program with 24-month, 36-month & and 48-month reviews to determine if they are still eligible for the program.
- Collected, modeled and evaluated on statistical pharmacy and claim data.
Plan Support Specialist
Imagine360
04.2022 - 10.2022
- Created outbound or outreach calls to providers, facilities and specialists on behalf of members seeking assistance
- Worked with multiple insurance companies that member plans are in-network to be seen by provider offices for appointments
- Assisted with creating intake forms for members who needed DME and scheduled appointments on behalf of the member in need
- Provided and created provider letters with listings of potential offices that are willing to service the member s a new patient.
Client Services Technical Support Specialist
AVAILITY, LLC
08.2021 - 03.2022
- Top customer service performance to helping doctors and billing companies with handling and managing day-to-day transactions such as billing claims, authorizations & referrals, eligibility & benefits, and EFT/ERA enrollments
- Assisted with handling successful technical support issues using Salesforce and the Availity site portal to create payer tickets and escalations
- Helped Availity Customer Service (ACS) department reach the daily call metrics Volume of 45-50 calls handed daily.
- Interacted with team members across departments to research and resolve customer issues.
- Provided excellent customer service by following up with clients, mailing applications, and responding to incoming calls.
- Responded to all client inquiries and asked appropriate questions to facilitate resolution.
Risk Adjustment Associate
Florida Blue/BCBSFL
04.2019 - 08.2021
- Collected and procured medical records from completing outreaches to provider offices for HEDIS and (RADV & CONRADV) risk adjustment audits assigned to Florida Blue Medicare team
- Assisted the Florida Blue Medicare department with successfully procuring a 94% medical record chart retrieval rate for RA audits and CMS audits
- Provided helpful feedback with experiences on how to successfully retrieve medical records from doctors, facilities, and hospitals
- Utilized proficiently systems such as DIAMOND, and Blue Square, and multiple EMR/HER systems such as AthenaNET, Allscripts EHR & EPIC EMR Systems.
- Reviewed contracts and agreements to identify potential risks and ideal mitigation strategies.
ROI Specialist
Iron Mountain
06.2018 - 01.2019
- Provided high quality customer service in a call center to assist and help clients retrieve medical records through mailed, faxed, or emailed medical records request daily
- Assisted payer companies with batch audits, internal mitigation audits, and risk adjustment (RADV) audits to complete in a timely manner for different projects
- Utilized the medical records software system EPIC to create tickets and find archived and recent medical records for UF Health Gainesville and Jacksonville.
- Processed medical records requests from outside providers according to facility, state, and federal law.
- Maintained patient records in compliance with security regulations.
ROI Specialist /Lead Document Image Technician
CIOX Health
02.2015 - 01.2018
- Accomplished dual duties as an ROI specialist assisting patients and clients with retrieving records by request via e-mail, fax, or mail and as a lead document image tech overseeing operations with uploading documents from discharges of patients from the St.Vincent’s Healthcare facility.
- Assessed customer needs and examined order contents to identify processing requirements and timelines.
- Continued and maintained a steady flow of medical record retrieving by prepping the documents, uploading them on an industrial scanner and quality controlling (QC), and validating the documents as they are being uploaded
- Successfully led the team to completion of retrieving and properly uploading records in the system with no errors created.
Education
Certified Risk Adjustment Training - Medical Insurance Coding
AAPC/Florida Blue
Jacksonville, FLHigh School Diploma -
Terrebonne High School
Houma, LAMedical Billing & Coding Certification - Medical Insurance Coding
Florida Technical College
DeLand, FL10.2023
Certified Public Notary - Notary Public
State Of Florida
Jacksonville, FL01.2021
Skills
- Attention to Detail
- HEDIS Audits
- HIPAA Compliant
- Cisco Jabber Software Knowledge
- Availity Essential Site Knowledge
- Technical Support
- Salesforce Software Knowledge
- Microsoft Office
- Medical Terminology
- Public Relations
- HIPAA Guidelines
- Managed Care
- Operational Requirements
References
AVAILABLE PER REQUEST
Affiliations
AHIMA
NNA
AAPC
Timeline
Health Program Representative II
Elevance Health/Amerigroup
01.2023 - 08.2023
Plan Support Specialist
Imagine360
04.2022 - 10.2022
Client Services Technical Support Specialist
AVAILITY, LLC
08.2021 - 03.2022
Risk Adjustment Associate
Florida Blue/BCBSFL
04.2019 - 08.2021
ROI Specialist
Iron Mountain
06.2018 - 01.2019
ROI Specialist /Lead Document Image Technician
CIOX Health
02.2015 - 01.2018
Certified Risk Adjustment Training - Medical Insurance Coding
AAPC/Florida Blue
High School Diploma -
Terrebonne High School
Medical Billing & Coding Certification - Medical Insurance Coding
Florida Technical College
Certified Public Notary - Notary Public
State Of Florida
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