Jyasemyne M. Brooks
Pearland/Houston,Texas
Summary
Detail-oriented and results driven team lead with 10+ years of combined experience in claims operations, specializing in coverage determination, complaint resolution, and data analysis. Demonstrates exceptional organizational skills and a commitment to excellence, fostering teamwork and efficiency across multiple departments. Proficient in Microsoft Office and multiple claims processing programs, dedicated to continuous improvement and operational efficiency.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Team Lead, Surest Claims Operations/Acting Supervisor
UnitedHealth Group
03.2023 - Current
- Serves as subject matter expert (SME), providing expertise to support 4 claim operations processing teams, ensuring adherence to policies and procedures and enhancing overall team performance
- Spearheads initiatives to streamline claim processing workflows, reducing errors and improving processing times, contributing to increased member satisfaction and operational efficiency
- Proactively identifies potential problems and trends, investigates them, and provides solutions using defined processes and expertise
- Collaborates with claims processors, teams, and supervisors to improve individual and team quality, technical skills, and efficiency through targeted coaching and comprehensive training on various claims processing programs (i.e CSR Portal Prod, Surest Admin Portal, QuickClaim- SDS, Quantum Choice Client, etc.)
- Facilitates regular team meetings and feedback sessions, fostering a culture of continuous improvement and knowledge sharing amongst claims staff
Senior Recovery/Resolutions Representative
UnitedHealth Group
11.2021 - 03.2023
- Accurately entering all patients billing and demographic information into multiple databases.
- Reviewed and processed medical claims utilizing standard operating procedures on claims processing system to identify and process claims accurately
- Resolved complex claims issues by manually adjusting escalated claims and ensured accurate adjudication
- Identified discrepancies, verified pricing, confirmed prior authorizations, and processed claims accurately for payment
- Provided expertise daily with managing subrogation files
- Using multiple claims processing programs to research patients' data and information
- Met production and quality standards by consistently achieving monthly goals, maintaining 98% payment accuracy, 95% procedural accuracy, and 99% financial accuracy quality standard and processing over 60 claims per day
- Ensured adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Maintained a dedicated work area to keep all member and company sensitive documents secure and HIPAA compliant
Public Health Data Management Specialist
Houston Health Department
09.2017 - 10.2021
- Streamlined COVID-19 data management, enhancing system efficiency and training staff on new protocols for improved response capabilities
- Conducted trainings during deactivation process so that pertinent staff would be knowledgeable and understand how to properly execute functionalities for response
- Implemented modification to existing process to save time and eliminate steps to original flow, gaining higher productivity in an overall fashion
- Coordinated the sorting, organizing, and uploading of communicable diseases from selected facilities such as laboratories, hospitals, and correctional facilities
- Using secure hospital databases such as (EPIC, THISIS, STD MIS & Global Scape)
- Transferred incoming labs to designated databases & filing sites depending on patient's diagnosis
- Provided support to the STD program manager by conducting Audits and quality assurance task
- Distributed labs to the appropriate employee to ensure proper disease intervention follow-ups
- Recorded data into EPIC, THISIS, STD Management Information System (STD MIS) patient portal for all out of jurisdiction client
- Collected and enter data for Congenital Syphilis, Gonorrhea & Chlamydia
- Managed providers follow up request for patients during pregnancy and after Labor & Delivery via phone & email
- Aided with quality assurance activities with administrative support staff
Office Manager
Home Expert Realty
08.2015 - 09.2017
- Coordinated the office schedule, scheduled meetings, and created mailings
- Organized new MLS listings, updated pending listings, and closed listings
- Coordinated the creation of marketing materials like brochures, renderings, Facebook pages, and website design
- Reviewed and implemented policies and procedures while providing status reports and contract assistance
- Collected rent payments and kept records of all payments received from all managed properties
- Answered incoming calls and made outbound calls to clients
Education
High School -
Texas Education Agency
11.2016 - 01.2017
Skills
- Analytical Thinking
- Teamwork
- Leadership
- Adaptability
- Conflict Resolution
- Documentation Review
- Data Entry
- Verbal and Written Communication
- Issue Resolution
- Computer Skills
- Microsoft Office
- Microsoft Teams
- Excel Spreadsheet
- Medical Claims Processing
- Time Management
- Project Management
- New Policies Processing
- Coordination of Benefits
- Eligibility Determination
- Settlement Determinations
- Coverage Assessments
- Customer Service
- Data Analysis
- Working efficiently within a remote setting
Certification
- Health Care Fraud, Waste and Abuse and Code of Conduct Annual Training, 2024
- 2024 Annual California Fair Claims Settlement Practices, 2024
- HIPAA Privacy Certification
- FEMA Incident Command Certification (100, 200, 700, & 800 Modules)
- AT&T 12 Week Customer Service Training Course
- Mayor Daley Computer Training Class (Certificate)
Profile Link
https://bold.pro/my/jyasemyne%2Dmbrooks/618r
Timeline
Team Lead, Surest Claims Operations/Acting Supervisor
UnitedHealth Group
03.2023 - Current
Senior Recovery/Resolutions Representative
UnitedHealth Group
11.2021 - 03.2023
Public Health Data Management Specialist
Houston Health Department
09.2017 - 10.2021
High School -
Texas Education Agency
11.2016 - 01.2017
Office Manager
Home Expert Realty
08.2015 - 09.2017
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