Susan Brewington
Columbia,SC
Summary
Experienced in ensuring community safety and security through emergency response, conflict resolution, and risk assessment. Recognized for strong team collaboration and adaptability to changing needs. Dedicated professional committed to maintaining public order and safety. Background in medical claims analysis, skilled at ensuring accurate and timely processing of healthcare claims. Proficient in data management, compliance, and problem-solving with a keen eye for detail. Emphasizing team collaboration and achieving results while being adaptable to changing needs and reliable in high-pressure environments. Possessing strong analytical skills and a thorough understanding of healthcare regulations and insurance policies.
Overview
21
21
years of professional experience
Work History
Medical Claims Analyst
America’s 1st Choice – AFC
12.2009 - 12.2016
- Analyze and review insurance medical claims of insurer to ensure accuracy, completeness, and eligibility
- Review medical billings for the reasonableness of tests, procedures, and hospital stay
- Research and adjust claims when necessary
- Determine basic eligibility of insurer coverage and payout amount of submitted claim from the insurer, perform all calculations
- Create written correspondence to provide clarification on the status of claims filed and follow up request for additional information
- Initiate/ conduct verbal correspondence to ensure customer service satisfaction was achieved
- Provide explanation of benefits to the insurer and their families
- Train new employees on entering and processing health care claims
- Resolve issues/complaints called in by insurer or providers
- Serve as an alternate receptionist to answer incoming calls and transfer calls to the appropriate person
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Maintained regulatory compliance by staying current with industry guidelines, state laws, and federal regulations.
Telecommunicator
Charlotte Mecklenburg Police Department
07.1999 - 07.2000
- Answered 911 Emergency and administrative incoming calls and determined action to be taken
- Operated police radio promptly and accurately dispatched field units for service calls
- Operated Center’s switchboard
- Coordinated emergency services
Telecommunicator
Lexington County Sheriff’s Department
09.1998 - 06.1999
- Answered and entered incoming calls on 911
- Operated police radio promptly and accurately dispatch field unites for service calls
- Analyzed information on multiple computer screens such as the National Criminal Instant Check database
- Utilized intelligence data to relay to fellow police officers
- Maintained the front desk, greet and relay information to the incoming public
Public Safety Officer/Dispatcher
South Carolina State Museum
02.1998 - 09.1998
- Monitored day-to-day operations of the facility
- Monitored incoming patrons coming to tour the facility
- Recorded daily activities in log books
- Dispensed keys and check packages
- Operated facility computers and cameras
- Rearmed and disarmed the building as needed
- Answered incoming calls for staff and transferred phone calls
- Patrolled assigned areas on foot or by vehicle.
- Maintained accurate records of incidents and actions taken during shifts, contributing to effective communication between team members and supervisors.
- Performed crowd control duties during large gatherings or events, maintaining order while prioritizing the safety of all attendees.
- Monitored surveillance systems for potential threats or suspicious behavior around critical infrastructure, reporting findings to appropriate authorities for further investigation.
- Managed high-stress situations to ensure caller calmness, using effective communication and problem-solving skills.
Detention Officer
Mecklenburg County Sheriff’s Office
02.1996 - 02.1998
- Handled the care, safety, orders, and discipline of 56 offenders in the housing unit
- Operated the facility control room that included the facility computer cameras and phones
- Wrote incident reports
- Recorded confidential information in daily log books
- Responded to emergency calls by follow officers and executed fire drills
Education
Business Management
South Carolina State University
Orangeburg, SCBusiness Management/ Marketing Concentration
Midlands Technical College
Columbia, SCSkills
- Claims processing proficiency
- HIPAA compliance
- Training and mentoring
- Medical terminology
- De-escalation strategies
- Report preparation
- Background in law enforcement
- Public safety
- Critical thinking
- Dispatch communication
- Report writing
Timeline
Medical Claims Analyst
America’s 1st Choice – AFC
12.2009 - 12.2016
Telecommunicator
Charlotte Mecklenburg Police Department
07.1999 - 07.2000
Telecommunicator
Lexington County Sheriff’s Department
09.1998 - 06.1999
Public Safety Officer/Dispatcher
South Carolina State Museum
02.1998 - 09.1998
Detention Officer
Mecklenburg County Sheriff’s Office
02.1996 - 02.1998
Business Management/ Marketing Concentration
Midlands Technical College
Business Management
South Carolina State University
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