Summary
Overview
Work History
Education
Skills
References
Timeline
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Jody Brightwell

Lawrenceville,GA

Summary

Accomplished Claims Specialist with extensive experience at Anthem, demonstrating mastery in HCPCS Code Proficiency and exceptional organizational skills. Achieved a 95% accuracy rate in claims processing, which led to a 30% reduction in claim rejections through detailed data analysis and precise coding corrections. Expertise in maintaining HIPAA compliance while enhancing customer satisfaction through effective problem resolution. Committed to leveraging analytical skills to foster operational efficiency and elevate service standards.

Overview

8
8
years of professional experience

Work History

Claims Specialist

Anthem
12.2021 - 10.2024
  • Reviewed and processed up to 60 insurance claims daily for accuracy and completeness, ensuring adherence to company policies and industry standards
  • Utilized claims management software such as Facets and NextGen to input, track, and update claim statuses, achieving a 95% accuracy rate in data entry and processing
  • Verified patient information, insurance eligibility, and benefit coverage, reducing claim rejections by 15% through proactive identification of discrepancies
  • Collaborated with team members and insurance providers to resolve 10+ claim inquiries per day, improving resolution times and customer satisfaction
  • Maintained compliance with HIPAA regulations and payer guidelines while processing claims and handling sensitive patient data
  • Implemented coding corrections (CPT, ICD-10, and HCPCS) and reviewed modifiers using coding software such as EncoderPro and 3M CodeFinder, reducing claim rejections by 30% within six months
  • Collaborated with insurance providers, including Medicare, Medicaid, and private insurers, to verify eligibility and ensure timely payment processing, achieving an average reduction of claim processing time by 15%
  • Analyzed claim data trends using Tableau and Excel to identify recurring errors and implemented procedural improvements, leading to a 20% increase in first-pass claim approvals

Data Entry Specialist

Piedmont Hospital
07.2019 - 11.2021
  • Determines covered medical insurance losses by studying provisions of policy or certificate
  • Establishes proof of loss by studying medical documentation, assembling additional information as required from outside sources
  • Collaborated with healthcare providers, clinical staff, and medical coders to resolve discrepancies in patient records and maintain data integrity
  • Execute clerical duties such as data entry, filing files, email management, calendar scheduling, and word processing
  • Entered patient information, including demographics, medical histories, test results, and treatment plans, into Electronic Health Records (EHR) and Electronic Medical Records (EMR) systems with a 99% accuracy rate
  • Conducted routine audits of medical records to identify errors, implement corrections, and improve data accuracy and quality
  • Working directly with auto insurance companies, health insurance companies, and attorney offices to verify claim information on the patient's behalf
  • Meeting monthly collection goals within the department
  • Ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations

Intake Specialist

Jackson Revenue Management
01.2017 - 07.2019
  • Provided clerical support Remotely for medical providers by copying documents, scanning and filing records in electronic and hard copy formats and mailing correspondence to patients as directed
  • Requests health plan authorizations/information as required; either electronically or verbally
  • Streamlined data entry processes by implementing best practices, reducing input errors, and improving workflow efficiency within the healthcare administration team
  • Communicate with customers or third parties to gather or provide essential file information, ensuring compliance with quality and process standards
  • Entered data into the system with speed and accuracy, averaging 50 wpm
  • Reviewed new patient’s orders and documentation submitted by referral sources to obtain required documentation and clinical requirements of individual health insurance plans, allowing our patients to maximize their available health plan benefits and to receive the much-needed care as soon as possible
  • Supported data migration projects, including transferring patient information from paper-based systems to digital formats, ensuring compliance with health IT standards

Education

Health Information Management -

Western Governor’s University
11.2024

Medical Billing and Coding -

Gwinnett College
12.2016

Skills

  • Claims Management
  • Strong organizational and time-management skills
  • Prior Authorization
  • HCPCS Code Proficiency
  • Consistent Accuracy
  • Insurance Claims Processing
  • Microsoft Excel
  • Data Entry Precision
  • Data Analysis Expertise
  • EPIC
  • Medical Terminology
  • EHR/EMR Systems
  • Medical Record Auditing
  • HIPAA Regulatory Adherence
  • Digital Correspondence
  • Clinical Documentation Management
  • Attention to Detail
  • Meditech
  • ICD-10
  • CPT
  • CRM Software Proficiency

References

References available upon request.

Timeline

Claims Specialist

Anthem
12.2021 - 10.2024

Data Entry Specialist

Piedmont Hospital
07.2019 - 11.2021

Intake Specialist

Jackson Revenue Management
01.2017 - 07.2019

Health Information Management -

Western Governor’s University

Medical Billing and Coding -

Gwinnett College

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