Selena Brown

Mercalis
Dates of Employment: Oct 2024 - Present

• Supervised a team of 6 staff members utilizing CLS, a Salesforce-based system, to manage healthcare program workflows.
• Monitored and corrected individual productivity, ensuring adherence to performance standards and turnaround times.
• Developed and implemented standard operating procedures to improve efficiency and consistency in team output.
• Tracked daily attendance, conducted behavior reviews, and addressed performance issues in a timely and professional manner.
• Provided regular feedback and coaching to team members, fostering accountability and professional development.
• Collaborated with upper management to align departmental goals with company objectives and compliance standards.

Professional Experience

· Reinburstment Case Management
Mercalis – [Mooresville]
Dates: Jan 2023– Sep 2024

- Oversaw benefit investigations, prior authorizations, and patient enrollment workflows.
- Ensured team performance through coaching, behavior management, and real-time productivity monitoring.
- Collaborated with internal departments to align processes with payer requirements and compliance standards.
- Delivered a service that promoted quicker access to therapy for patients and providers.

- Managed daily operations for a medical office, including direct interaction with patients and HCPs.
- Verified insurance, obtained prior authorizations, and coordinated with providers to ensure accurate and timely care.
- Handled patient intake, scheduling, and billing tasks while maintaining compliance with HIPAA guidelines.

• Resolves problems related to drug interactions, dependencies, and department processes.
• Supervise a team of 22 people.
• Analyzes distribution and supports pharmacists, pharmacy technicians, and support staff.
• Assists Pharmacists in medication preparation and dispensing directly or through program/process development.
• Complies with all Drug Enforcement Administration (DEA), Centers for Medicare & Medicaid Services (CMS), federal, state, and company regulations, policies, and procedures.
• Make decisions are typically related to schedule, plans and daily operations.
• Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates.
• Ensures consistency in execution across team. Holds team members accountable for following established policies.

• Greeted and welcomed guests as soon as they arrive at the office.
• Directed visitors to the appropriate person and office.
• Answered, screened and forwarded incoming phone calls.
• Ensured reception area is tidy and presentable, with all necessary stationery and material (e.g. pens, forms and brochures).
• Provided basic and accurate information in-person and via phone/email.
• Received, sorted and distributed daily mail/deliveries.
• Maintained office security by following safety procedures and controlling access via the reception desk (monitor logbook, issue visitor badges).
• Ordered front office supplies and keep inventory of stock.
• Updated calendars and schedule meetings.
• Arranged travel and accommodations, and prepare vouchers.
• Kept updated records of office expenses and costs.
• Performed other clerical receptionist duties such as filing, photocopying, transcribing and faxing.
• Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
• Processed a high volume of claims on a daily basis using established time frames.
• Assisted new policyholders with processing claims.
• Verified accuracy of provider data entered into the system including tax ID numbers, NPI numbers, address changes .

• Communicated with insurance agents and beneficiaries.
• Prepared claim forms and related documentation.
• Reviewed claim submissions and verifying the information.
• Recorded and maintaining insurance policy and claims information in a database system.
• Determined policy coverage and calculating claim amounts.
• Processed claim payments.
• Complied with federal, state, and company regulations and policies.
• Performed other clerical tasks, as required.

• Assigned codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes.
• Ensured codes are accurate and sequenced correctly in accordance with government and insurance regulations.
• Followed up with the provider on any documentation that is insufficient or unclear.
• Communicated with other clinical staff regarding documentation.
• Searched for information in cases where the coding is complex or unusual.
• Received and review patient charts and documents for accuracy.
• Reviewed the previous day's batch of patient notes for evaluation and coding.
• Ensured that all codes are current and active.