Nicole Brunner
Jersey City
Summary
Results-driven overpayment recovery specialist with expertise in medical terminology, ICD-10, and claims analysis. Known for attention to detail and effective communication skills, ensuring accurate recovery processes and resolution of discrepancies.
Overview
29
29
years of professional experience
Work History
Overpayment recovery specialist
Healthfirst Insurance
New York
01.2021 - Current
- Analyze payment histories,claims data, and provider records to find overpayments. Confirm overpayment amounts and initiate recovery process, managing logs, and adjusting claims. Contact providers, member other parties via phone, email or letter to resolve diserepancies and arrange repayments. Mantain detailed records for audits and prepare reports for leadership on recovery status, work with billing compliance, and clinical teams to prevent future errors. Aherere to payer policies CPT ,ICD-10 coding and Federal/ State regulations
Claims Examiner
Healthfirst Insurance
New York
12.2014 - 01.2021
- Claims Adjudication process to assure that all claims are adjudiated in accordance with cms rules and regulations, review all line of business, inpatient claims and outpatient claims, commerical claims, APG, HARP, Readmission, Dirty and Harp claims, authorize claims payments process refunds and letters of dual coverage,(when applicable) identify process improvement opportunities within claim department and recommend systems enhancement handle any additional responsibility
Enrollment Specialist
Horizon BCBSNJ
Newark
01.2012 - 12.2014
- complete Medicare applications for new Enrollees with respect, courtesy and fairness in the way that provides superior Customer services, Complete Medicare application in a fashion participant or primary caregiver in the completion of Medicare application, submit documention to Human Resources Adminstration with specified time/frame to assure Medicare coverage for participate track the Medicare status for all new enrollees , assist intake and care teams in confirming eligibility upon referrals, by enrollment or care teams matains records on every member to show covearge statues and timing recertification applications in CCMS prepare/ submit monthly reports keep up to date with Medicare underwriting laws, call contact members
Claims Analyst
GHI INSURANCE
New York
09.1996 - 12.2011
- Payment dispute process across all line of business and is specifically responsible for the resolution of provider payment Reconsdieration Request to investigate the outcome of claim analyze provider request to investigate the outcome of claim payment or denial, determine the appropriate resolution using strict adherence to internal guidelines polices and procedures work with various Department when necessary, to determine root cause and appropriate resolution, remediate impacted . Follow up with insured individuals regarding premium and deductible payments, identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Education
Bachelor of Arts - Clinical Child Psychology
College of New Rochelle
Brooklyn, NY06-2005
Skills
- Medical terminology
- MS Office
- Excel
- ICD-10
- CPT codes
- MHS
- QCARE
- Citrix
- QBLUE
- CCMS
- MACESS
- 3M pricing
- Powerpoint
- Medical coding
- Pega, PegaSce
- Tabeau
- Val
- Vpay
- Truecare
- Sharpoint
- Cotiviti
- Optum
- FWA
Timeline
Overpayment recovery specialist
Healthfirst Insurance
01.2021 - Current
Claims Examiner
Healthfirst Insurance
12.2014 - 01.2021
Enrollment Specialist
Horizon BCBSNJ
01.2012 - 12.2014
Claims Analyst
GHI INSURANCE
09.1996 - 12.2011
Bachelor of Arts - Clinical Child Psychology
College of New Rochelle