Kelly Brightman
San Diego,CA
Summary
Results-driven professional with extensive experience in client account management. Proven ability to develop strong client relationships and implement effective strategies that drive business growth. Known for collaborative efforts and adaptability in dynamic environments, with strong analytical and communication skills. Detail-oriented Account Specialist focused on resolving issues and maintaining customer loyalty. Strong critical thinking skills with a methodical approach. Knowledgeable about Health care practices and documentation requirements.
Overview
9
9
years of professional experience
Work History
Provider Account Specialist
Sharp Health Plan
12.2024 - Current
- Strengthened provider networks through regular outreach and relationship building activities.
- Collaborated with internal departments to resolve complex provider issues, maintaining positive relationships and open communication channels.
- Fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on-site enrollment opportunities.
- Contributed to and enhanced audit processes to maximize quality management standards.
- Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
- Identified network gaps and collaborated with recruiters to fill deficiencies.
- Participated in cross-functional teams tasked with improving overall performance metrics within the organization''s Provider Relations department.
Provider Services Representative
Molina Healthcare
10.2021 - 12.2024
- Collaborated with cross-functional teams to resolve complex provider issues, resulting in improved provider relations.
- Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
- Assisted in developing policies that improved overall provider satisfaction and compliance.
- Ensured compliance with healthcare regulations and standards through diligent provider monitoring and education.
- Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
- Enhanced provider engagement with introduction of user-friendly online portal.
- Improved provider satisfaction by promptly addressing and resolving service issues.
- Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
- Educated customers about billing, payment processing and support policies and procedures.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Met customer call guidelines for service levels, handle time and productivity.
- Trained new personnel regarding company operations, policies and services.
Fraud Detection Analyst
Barclays US
01.2019 - 08.2021
- Increased efficiency of fraud detection systems by continuously optimizing monitoring processes and procedures.
- Maintained a high level of knowledge about emerging fraud schemes, enabling proactive response to potential threats.
- Evaluated customer data to identify and prevent fraudulent activities.
- Reviewed reports and individual transactions which appeared suspicious to uncover possible fraudulent activity.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
- Tracked fraud cases and monitored trends to develop strategies for prevention.
- Performed risk assessments to determine level of fraud risk and prioritize investigations.
- Contacted customers directly to notify of fraudulent activity and minimize impacts.
- Reviewed transactions and receipts to identify any suspicious activity.
- Reduced instances of fraud by proactively identifying patterns and trends in fraudulent activities.
Provider Services Representative
Aetna Better Health of California
06.2016 - 12.2017
- Collaborated with cross-functional teams to resolve complex provider issues, resulting in improved provider relations.
- Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
- Analyzed performance metrics for assigned territory, identifying opportunities for growth and improvement within the network.
- Improved provider satisfaction by promptly addressing and resolving service issues.
- Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
- Supported network development efforts through proactive outreach to potential providers and initiation of contracting processes.
- Educated customers about billing, payment processing and support policies and procedures.
- Met customer call guidelines for service levels, handle time and productivity.
Benefits Specialist
Covance
06.2016 - 12.2017
- Streamlined communication processes between employees, management, and insurance carriers for efficient handling of claims and disputes.
- Reduced errors in benefits investigations by conducting thorough reviews and maintaining up-to-date knowledge on regulations.
- Improved client satisfaction with timely responses to inquiries and accurate benefit determinations.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Analyzed information gathered by investigation and reported findings and recommendations.
Education
Bachelor of Arts - International Relations
San Francisco State University
San Francisco, CASkills
- Proficient in Microsoft Office Suite
- Analytical Problem-Solving
- CRM System Proficiency
- Effective Communication
- Effective Time Management
- Clear Communication Skills
- Effective Sales Presentations
- Problem-Solving Skills
Timeline
Provider Account Specialist
Sharp Health Plan
12.2024 - Current
Provider Services Representative
Molina Healthcare
10.2021 - 12.2024
Fraud Detection Analyst
Barclays US
01.2019 - 08.2021
Provider Services Representative
Aetna Better Health of California
06.2016 - 12.2017
Benefits Specialist
Covance
06.2016 - 12.2017
Bachelor of Arts - International Relations
San Francisco State University
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