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Katherine Brown
Charlotte,NC
Work Preference
Summary
Experienced healthcare professional with a strong background in care coordination, claims adjudication, and benefits administration. Proven ability to analyze complex clinical documentation, verify insurance coverage, and ensure precise, compliant record-keeping. Skilled in Epic EHR navigation, regulatory standards (HIPAA), and payer-specific guidelines. Adept at auditing claim details, identifying coding discrepancies, and supporting revenue cycle integrity. Seeking to leverage analytical problem-solving and quality-assurance expertise in a professional coding or clinical audit role.
Overview
10
10
years of professional experience
Work History
Care Coordinator
Atrium Health
Charlotte, NC
04.2025 - Current
- Referral & Care Coordination: Coordinated GI referrals, complex follow-up visits, and ancillary services, managing high-volume workflows in collaboration with providers, specialists, and multidisciplinary teams to ensure timely execution of physician orders.
- Insurance Authorization & Verification: Navigated payer guidelines to obtain crucial insurance authorizations for procedures and specialty care; verified patient eligibility and resolved complex payer-related issues to prevent claim delays.
- Electronic Health Record (Epic) Management: Maintained meticulous patient records within Epic, accurately documenting laboratory and imaging files to ensure clinical data integrity and strict regulatory compliance.
- Information Release & Continuity of Care: Processed and securely transmitted medical records within strict organizational timeframes, supporting seamless continuity of care across facilities.
- Compliance & Privacy Standards: Ensured rigorous adherence to HIPAA regulations, internal program operations protocols, and diverse payer guidelines across all patient and provider touchpoints.
Patient Advocate
HealthSmart
05.2022 - 04.2025
- Served as a liaison between patients, healthcare providers, and insurance companies to resolve complex issues and improve overall patient satisfaction.
- Assisted patients in understanding diagnoses, treatment options, and associated costs, improving comprehension through clear, supportive communication.
- Educated patients on health insurance plans, coverage, claims processing, and appeals, reducing confusion and minimizing claim errors and delays.
- Investigated and resolved billing discrepancies, denied claims, and authorization issues by coordinating with payers and providers.
- Navigated insurance systems to verify benefits, eligibility, and coverage details, ensuring accurate information and timely processing.
- Documented all interactions and case updates in internal systems, maintaining compliance with HIPAA and organizational standards.
- Managed a high-volume caseload while meeting performance metrics, turnaround times, and quality standards.
Claims Processor
Aetna
03.2018 - 02.2020
- Reviewed and processed medical insurance claims in accordance with policy guidelines, ensuring accuracy and timely adjudication.
- Verified member eligibility, benefits, and coverage to determine claim validity and reduce processing errors.
- Investigated complex claims by reviewing documentation, medical records, and policy details; collaborated with providers when needed.
- Determined claim payments based on contract terms, coding, and medical necessity guidelines.
- Identified discrepancies and potential issues, escalating or resolving to prevent claim denials and rework.
- Maintained detailed documentation of claim decisions while ensuring compliance with regulatory and company standards.
Benefits Specialist (Starbucks Account)
Randstad | Aon Hewitt
The Woodlands, TX
07.2016 - 02.2018
- Administered employee benefits programs including health insurance, retirement plans, and paid time off, ensuring compliance with federal and state regulations.
- Verified benefits eligibility, coverage details, and plan enrollments to support accurate processing and reduce discrepancies.
- Communicated benefit plan options, changes, and enrollment processes to employees while maintaining clear and accurate documentation.
- Coordinated with insurance carriers and third-party administrators to resolve coverage issues and discrepancies.
- Maintained and updated employee benefit records in internal systems, ensuring data accuracy and compliance standards.
- Assisted with open enrollment processes, including plan setup, employee support, and issue resolution.
- Analyzed employee benefits programs to ensure compliance with regulations and organizational policies.
- Developed and delivered training sessions on benefits enrollment procedures for staff members.
Education
GED -
University of Alaska Anchorage
Anchorage, AK07-2001
Skills
- Benefits Administration Software
- Healthcare & Insurance Systems
- HR & Payroll Systems
- Data Entry & Record-Keeping Systems
- Microsoft Office Suite
- Email & Ticketing Systems
- Financial Transaction Processing
- Administrative & Clerical Software
AREAS OF EXPERTISE
- Coding & Quality Assurance: Data Accuracy, Auditing Support, Revenue Cycle Integrity, and Denial Prevention.
- System Navigation: Extensive experience with Epic EHR, insurance portals, and electronic documentation management.
- Compliance & Regulations: Deep understanding of HIPAA guidelines, federal/state healthcare regulations, and payer-specific policies.
- Claims & Revenue Cycle: In-depth knowledge of claims processing, benefit verification, complex issue resolution, and appeals.
- Clinical Coordination: Managing high-volume referral workflows, physician orders, and medical necessity authorizations.
- Professional Strengths: High-volume workload handling, workflow optimization, cross-functional collaboration (Providers/Payers), and analytical problem-solving.
Timeline
Care Coordinator
Atrium Health
04.2025 - Current
Patient Advocate
HealthSmart
05.2022 - 04.2025
Claims Processor
Aetna
03.2018 - 02.2020
Benefits Specialist (Starbucks Account)
Randstad | Aon Hewitt
07.2016 - 02.2018
GED -
University of Alaska Anchorage