Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

RIANBRA BRAXTON

Riverview,FL

Summary

Diligent Claims Processor versed in insurance processes and/or claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate different systems. Effective at operating within regulations and department guidelines to manage telephone calls, emails, letters and in-person requests for assistance. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Experienced Data Entry/Customer Service with over 10 years of experience in Customer Service. Excellent reputation for resolving problems and improving customer satisfaction. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Customer Service/Claims Analyst position. Ready to help team achieve company goals. Reliable employee seeking Data Entry/Customer Service position. Offering excellent communication and good judgment.

Overview

17
years of professional experience

Work History

Sherloq Solutions
Riverview, FL

Specialist, Insurance Revenue Cycle
11.2022 - Current

Job overview

  • Process claims from work queue
  • Input data into FACS
  • Maintain a constant increased production/quality rate.
  • Analyzed information gathered by investigations to report findings and recommendations.
  • Verified client information by analyzing existing evidence on file.
  • Checked documentation for accuracy and validity on updated systems.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Generated, posted and attached information to claim files.
  • Evaluated accuracy and quality of data entered into agency management system.
  • Maintained confidentiality of patient finances, records and health statuses

Cognizant Technologies Solutions
, FL

Claims Processor/Subrogation UR
06.2021 - Current

Job overview

  • Process claims from work queue
  • Resolve claim errors via Facets Interface
  • Maintain a constant increased production/quality rate
  • URs Refunds/Subrogation
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Analyzed information gathered by investigations to report findings and recommendations.
  • Verified client information by analyzing existing evidence on file.
  • Checked documentation for accuracy and validity on updated systems.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Posted payments to accounts and maintained records.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Generated, posted and attached information to claim files.
  • Evaluated accuracy and quality of data entered into agency management system.

FIRSTSOURCE SOLUTIONS
RIVERVIEW, FL

Claims Processor
09.2020 - 03.2021

Job overview

  • Managed claims from medical providers for the life cycle of each patient case
  • Analyzed, validated, and processed information for the claim of payments
  • Thoroughly reviewed claims for accuracy and ensured that they met operational standards
  • Complied with state laws, policy and company procedures
  • Entered CPT codes and verified data for computer processing as required and identified 1500 and UB-04 forms
  • Claim processor (CPT, ICD-9-CM, ICD-10-CM and HCPCS Level .

WIPRO/HEALTH PLANS
TAMPA, FL

Quality Assurance Auditor
03.2019 - 06.2020

Job overview

  • Holding calibrations as well as meetings with the business unit and CCA’s to improve scores, send trend reporting
  • Quality assurance auditor
  • In charge of auditing all claims received
  • Ran daily report, to complete WOA’s, MACOPS and Fallouts
  • Inspected work areas regularly to identify safety practices, quality control procedures and worker actions in need of improvement.
  • Coaching, ATA’s, Calibrations
  • Trainee (Processor SME)
  • Claim processor (CPT, ICD-9-CM, ICD-10-CM and HCPCS Level II
  • Work-from home auditor

PERFORMAX PHYSICAL THERAPY
LIVONIA, MI

Medical Receptionist
09.2018 - 12.2018

Job overview

  • Answer phones; route to appropriate individual and answer patient inquires
  • Schedule new and follow up appointments
  • Verify all patient insurance, take new patient information
  • Assist in all procedures prior to and following a physical therapy visit

HENRY FORD HEALTH SYSTEM
DETROIT, MI

Insurance Verification Specialist
11.2017 - 11.2018

Job overview

  • Maintained and updated insurance information for all patient files
  • Coordinated patient data collation with various external referral sources
  • Informed patients of their financial responsibility for services to be render
  • Contacted insurance companies to obtain and enter accurate benefit information to processing and minimize rejections

MYRTLE BEACH VACATION RENTALS INC
MYRTLE BEACH, SC

Administrative Assistant
06.2014 - 09.2017

Job overview

  • Worked closely with Controller and Director of Operations
  • Handled both incoming and outgoing cash flow from trust and operating accounts
  • Reconciled any financial discrepancies from homeowners, guest and vendors
  • Administered banking, deposits, account registry and payroll
  • Created, processed and filed both outgoing and incoming invoices
  • Drove business growth by recruiting, training, managing, and mentoring top-performing room’s division team members; developed employee morale, conducted informational weekly meetings, and completed performance reviews
  • Reviewed daily occupancy rates, analyzed rate variance, observed daily house count and monitored oversold dates
  • Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
  • Updated spreadsheets and databases to track, analyze and report on performance and sales data.

BLUE CROSS BLUE SHIELD
MYRTLE BEACH, SC

Claims Processor
10.2015 - 02.2016

Job overview

  • Managed claims from medical providers for the life cycle of each patient case
  • Analyzed, validated, and processed information for the claim of payments
  • Thoroughly reviewed claims for accuracy and ensured that they met operational standards
  • Complied with state laws, policy and company procedures
  • Entered CPT codes and verified data for computer processing as required and identified 1500 and UB-04 forms
  • Claim processor (CPT, ICD-9-CM, ICD-10-CM and HCPCS Level II

Kroger
Myrtle Beach, SC

Customer Service Supervisor
02.2007 - 06.2014

Job overview

  • Established and updated work schedules to account for changing staff levels and expected workloads.
  • Conducted training and mentored team members to promote productivity and commitment to friendly service.
  • Created, prepared and delivered reports to various departments.
  • Coached team members to deliver hospitable, professional service while adhering to set service models.
  • Assessed and authenticated customer exchanges, voids and returns.
  • Exceeded team goals and collaborated with staff members to implement customer service initiatives.
  • Researched and corrected customer concerns to promote company loyalty.
  • Set priorities and problem-solved workflow issues to maintain rapport with customers and managers.

Education

Horry Georgetown-Technical College

Associate of Applied Science from Administrative Tech Medical

Certificate – Professional Coder MedCerts/American Academy of Professional Coders

Skills

Able to integrate medical coding and payment policy changesundefined

Timeline

Specialist, Insurance Revenue Cycle

Sherloq Solutions
11.2022 - Current

Claims Processor/Subrogation UR

Cognizant Technologies Solutions
06.2021 - Current

Claims Processor

FIRSTSOURCE SOLUTIONS
09.2020 - 03.2021

Quality Assurance Auditor

WIPRO/HEALTH PLANS
03.2019 - 06.2020

Medical Receptionist

PERFORMAX PHYSICAL THERAPY
09.2018 - 12.2018

Insurance Verification Specialist

HENRY FORD HEALTH SYSTEM
11.2017 - 11.2018

Claims Processor

BLUE CROSS BLUE SHIELD
10.2015 - 02.2016

Administrative Assistant

MYRTLE BEACH VACATION RENTALS INC
06.2014 - 09.2017

Customer Service Supervisor

Kroger
02.2007 - 06.2014

Horry Georgetown-Technical College

Associate of Applied Science from Administrative Tech Medical

Certificate – Professional Coder MedCerts/American Academy of Professional Coders
RIANBRA BRAXTON