MONIQUE MOORE-BROWN
Maricopa,AZ
Summary
Dynamic Patient Care Technician with a proven track record at Express Scripts, adept in claims management and customer service. Excelled in complex problem-solving and relationship building, significantly enhancing workflow efficiency. Recognized for surpassing accuracy goals by 98%, showcasing expertise in Microsoft Office365 and exceptional interpersonal skills.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Patient Care Technician
Express Scripts
01.2020 - Current
- Manage Hundreds of Claims by Directing Litigation Processes Across Several Healthcare Sectors, with Attorneys & Insurance Companies, to Acquire, Maintain & File Reports in Patient Records
- Resolve Intricate Procurement Issues Raised in Pull Department
- Virtual Copying, Faxing, Data Entry, Transcription from Customer Support Interactions, & Manage Overall Communications to Elucidate Patient Benefits
- Initiate Investigations for Prescription Orders
- Perform Follow Up Calls on Prior Authorization, Appeals, & DOD Accounts
Claims Analyst
Centene Corporation
01.2016 - 01.2020
- Refined Electronic & Paper Claims for both Medicaid & Hospitals
- Analyzed, Reviewed, & Updated Claims for Accuracy, Completeness & Eligibility Review in order to meet Billing Requirements & Payer Demands
- Actively Managed Claims Process to Ensure Timely Resolution for Validity of Records
- Identified & Denied Duplicate Claims
- Team Lead Investigator of Missing Claims, Provider Info & EOB Accounts & Calculations
- Input Proper ICD-9/10 & CPT Codes & Attached Flawless Referral/Authorizations
- Reviewed Med
- Records for Optimal DRG Assignment & Reported Findings to Coding Manager
- Coded High $/Volume Inpatient Records (Cardio, Radio, Gastro, Neuro, etc.)
- Implemented State of the Art Formulas to Improve & Monitor Workflow for Daily/Weekly QA Status Reports
- Recognized as The Top 10 Analyst for Exceeding Accuracy & Attendance Goals by 98%
- Utilized Amisys to Determine Payment & Rejection Codes
Insurance Specialist
REMX Ltd.
01.2015 - 01.2016
- Entry, Audit, & Confirmation of Claims Data & Preferred Payments
- Processed Re-Verifications by contacting Existing Clients' Insurance Providers & Prior Authorizations
- Applied D.0 Regulations & Coding Guidelines to Claims Data; -4, ICD-9, ICD-10, HCPCS, ASA, & UB92 Codes/Billing Guidelines
Certified Pharmacy Technician
Q O L Meds
01.2014 - 01.2015
- Prescription Prep; Data Entry of Patient Demographics, Drug Allergies, Pharmaceutical History & Orders
- Superb Customer Service Skills while Greeting Patients, Phone Reception, & Filing
- Maintained Drugstore Cleanliness, Pulled/Stocked, Poured, Counted, Restock/Packaging, Labeling & Pricing Prescriptions, Mail Order, Balancing Cash POS & Sending in Receipts to Corporate
Education
Pharmacy Technician -
Remington College
LA01.2012
AS - Computer Electronics
Olive Harvey College
IL08.1991
H.S Diploma -
Bowen High School
IL01.1982
Skills
- Microsoft Office365 Software
- Customer Service
- Claims Investigation
- Complaint Resolution
- QA
- Risk Management Support & Reporting
- Relationship Building
References
Available Upon Request
Educationandlicenses
- AS in Computer Electronics, Olive Harvey College, Chicago, IL, 08/01/84, 05/01/87
- H.S Diploma, Bowen High School, Chicago, IL, 08/01/78, 05/01/82
- Certified Pharmacy Technician, ARIZONA BOARD OF PHARMACY, 09/30/26
- PTCB - Pharmacy Technician Certification Board, 09/30/26
Certification
- NPTA 10/2024
- Pharmacy Technician Billing & Reimbursement Certificate of Completion CPhT-Adv
- NPTA 10/2024
- Pharmacy Technician Regulatory Compliance Certificate of Completion CPhT-Adv
- PHARMCON 08/2024
- Certificate of Participation for Technicians CPhT-Adv
- Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board (PTCB).
- Advanced Certified Pharmacy Technician (CPhT-Adv) - Pharmacy Technician Certification Board (PTCB)
Timeline
Patient Care Technician
Express Scripts
01.2020 - Current
Claims Analyst
Centene Corporation
01.2016 - 01.2020
Insurance Specialist
REMX Ltd.
01.2015 - 01.2016
Certified Pharmacy Technician
Q O L Meds
01.2014 - 01.2015
Pharmacy Technician -
Remington College
H.S Diploma -
Bowen High School
- NPTA 10/2024
- Pharmacy Technician Billing & Reimbursement Certificate of Completion CPhT-Adv
- NPTA 10/2024
- Pharmacy Technician Regulatory Compliance Certificate of Completion CPhT-Adv
- PHARMCON 08/2024
- Certificate of Participation for Technicians CPhT-Adv
- Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board (PTCB).
- Advanced Certified Pharmacy Technician (CPhT-Adv) - Pharmacy Technician Certification Board (PTCB)
AS - Computer Electronics
Olive Harvey College
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