Karyn Branch
Conifer Health Solutions
Coral Springs,USA
27
years of professional experience
Managed analytical problem-solving and contract management to support accurate claims adjudication, staff development, and performance management while driving operational efficiency.
Work History
Manager, Terms and Conditions
11 Years 5 Months- Develops, coaches, monitors, and mentor staff.
- Conducts performance evaluations; schedules and approves overtime and takes disciplinary action, as necessary.
- Develop and approve recommendations to change systems, policies, and procedures; ensure timely and accurate implementation.
- Oversee Terms & Condition Team to ensure accuracy of claims adjudication system processes.
- Provided expertise on new contract loads, formatted and implemented necessary amendments and changes, and managed the rollover of contracts during client audits.
- Collaborated with Client Managed Care and adjudication software Account Rep to ensure contract profiles are pricing accurately, per contract language.
- Communicated with leadership to resolve discrepancies before month-end close.
- Escalates payer issues to applicable business units, clients, and leadership.
- Attended regular meetings with Client Managed Care, Conifer business units, and adjudication vendor.
- Participates in multiple facility accounts received/benefit inventory management and complex variance resolution.
- Identify trends and patterns in payer and internal behavior, communicated fiscal impact to stakeholders, and assisted in resolving contract issues and variances.
- Oversee bulk resolution projects by researching plan specifics, applying plan contracts, state, or other regulations as appropriate to ensure account balances are appropriate.
- Meets regularly with teams and payers to escalate issues and spur communication between provider and payers.
- Coordinate with Terms and Conditions, Plan Management, Plan Specialists, Third Party Collections, Disputes and/or the Credit teams, payers, and clients to help resolve issues.
- Exercises discretion in analyzing and identifying issues associated with reprice impact reports.
- Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff.
- Terms and Conditions Department | 07/2011 - Present
Managed Care Contract Analyst
3 Years 10 Months- Collaborated with managed care medical economics and med assets to ensure adherence to contract terms.
- Reviewed Terms and Conditions issues log to promptly resolve discrepancies affecting contract performance.
- Assisted departments with contract and account concerns to facilitate smooth operations.
- Analyzed and identified reprice impact reports, providing actionable recommendations for resolution.
- Requested plan codes and profile mappings for new contracts based on facility requirements.
- Executed projects, per management instructions, achieving deadlines and maintaining project integrity.
Specialist, Payment Discrepancy
2 Years 10 Months- Collaborated with Terms and Conditions, Plan Specialists, Third Party Collections, Disputes, and Credit teams to verify and correct account balances.
- Analyzed under and over payment data (disputed and credit balances) to identify patterns and escalated resolutions through bulk projects, collaboration with Terms and Conditions team on Fin Thrive adjudication issues, and coordination with Plan Specialists on recurring payment problems.
- Coordinated bulk resolution projects by researching plan specifics and applying relevant regulations to ensure accurate account balances.
- Documented findings for leadership and contract negotiators to facilitate future adjudication of executed contracts and reduce instances of under or over payments.
- Clarified current patterned issues for NIC team, outlining resolutions and guiding responses to affected accounts in daily routing.
- Assisted various departments by shadowing team members with job duties relating to contract interpretation, and/or utilization.
Specialist, Insurance Plan
2 Years- Coordinate efforts with Plan Manager to drive changes in the auto adjudication system to produce clean claims.
- Reviewed variances to expected reimbursement (disputed and credit balances) based on established guidelines, identified patterns, and escalated resolutions by creating bulk resolution projects and coordinating with management on the Medical Economics team.
- Generated daily, weekly, and monthly reports to ensure claim processing integrity per established guidelines from management.
- Facilitated meetings with Tenet Legal, Managed Care, and outside vendors to address compliance and operational issues.
- Providing concise documentation and reports to leadership, internal, and external partners.
Quality Assurance Analyst, Claim Processing
6 Years 3 Months- Analyzed claims data to identify trends and discrepancies, enhancing accuracy of reporting.
- Conducted audits of processed claims for accuracy, providing feedback to mitigate future errors.
- Mentored junior processors, fostering a collaborative environment focused on continuous improvement.
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
- Evaluated accuracy and quality of data entered into agency management system.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Maintained detailed records of all processed claims for easy retrieval during audits or disputes.
Education
Associates of Arts - Health Services Administration
Completed coursework
Diploma
Skills
HCPCS/CPT/ICD-10 coding
Medical terminology
Contract management systems (Fin Thrive/EPIC/Optum Payment Integrity Compass/Meditech)
Advanced query writing
Data analysis
Documentation and reporting
Project planning
Workflow management
Contract management
Performance management
Processes and procedures
Strong analytical abilities
Complex Problem-solving
Staff management
Team management
Effective communication skills
Decision-making
Advanced Microsoft Office
Timeline
Manager, Terms and Conditions
Conifer Health Solutions
05.2015 - CurrentRead More
Managed Care Contract Analyst
Conifer Health Solutions
07.2011 - 05.2015Read More
Specialist, Payment Discrepancy
Conifer Health Solutions
08.2008 - 06.2011Read More
Specialist, Insurance Plan
Tenet Healthcare Corporation
08.2006 - 08.2008Read More
Quality Assurance Analyst, Claim Processing
Anthem Blue Cross Blue Shield of Georgia
01.2000 - 04.2006Read More
Copiague Senior High School
Diploma
Read More
Keiser College
Associates of Arts from Health Services Administration
Read More