TRACEY J. BRADLEY
Dacula
Summary
Detail-oriented Healthcare ,Professional with a solid foundation in claims review and EHR systems. Skilled in documentation, workflow analysis, and troubleshooting to support operational reporting, provider and patient satisfaction. Actively advancing knowledge in Epic configuration and healthcare technology development for future contributions.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Claim Analyst III
Aetna / CVS Health
Atlanta
04.2025 - Current
- Reviewed and analyzed insurance claims for accuracy, completeness, and eligibility using QNXT and Claim Central to ensure compliance and mitigate risk.
- Validate claim details through policy review, medical records, and third-party documentation to determine coverage, liability, and potential fraud.
- Calculate and authorize payments while ensuring compliance with regulatory and organizational standards.
- Maintained detailed documentation, case summaries, and audit-ready records to enhance operational reporting and facilitate audits.
- Supported patient and staff workflows by assisting users in navigating digital tools and healthcare processes to improve service delivery.
- Remote
Patient Success Lead
Walmart Health
Loganville
02.2023 - 04.2025
- Facilitated patient and staff workflows, guiding users in Epic navigation, scheduling, and digital tools to enhance usability.
- Created and maintained outreach workflows in Salesforce, ensuring accurate records for improved reporting and operational efficiency.
- Collaborated with cross-functional teams to improve communication workflows and enhance patient engagement.
- Provided frontline troubleshooting, identifying issues, replicating errors, and escalating complex problems appropriately.
- Developed training resources and provided workflow documentation to enhance onboarding and knowledge sharing.
Executive Team Lead
Oak Street Health
Atlanta
01.2021 - 02.2023
- Documented outreach workflows to identify gaps, enabling targeted process optimization.
- Trained staff on Medicare guidelines, communication strategies, and patient engagement workflows.
- Cultivated relationships with clinical and community partners to enhance support for patient needs.
- Developed intake and lead-tracking forms to streamline documentation and enhance data accuracy.
- Led team meetings to address issues, share updates, and reinforce best practices.
Medicare Advisor
Centene
Atlanta
01.2019 - 01.2021
- Guided clients through Medicare Advantage enrollment, benefits navigation, and supplemental services to enhance their understanding and access to healthcare.
- Assessed client needs and followed up to ensure satisfaction and continuity of care, fostering trust and long-term relationships.
- Established partnerships with medical and dental providers to strengthen community outreach and improve service access for clients.
- Provided remote support during COVID-19, demonstrating adaptability and strong communication skills.
Senior Benefits Consultant
Goshen Enterprise Marketing
Lithonia
03.2017 - 01.2019
- Clarified complex Medicare and benefits information for diverse audiences, enhancing understanding and accessibility.
- Applied strong analytical and problem-solving skills to effectively resolve participant concerns, improving client satisfaction.
- Maintained detailed documentation of client interactions, benefits inquiries, and resolution steps.
- Trained new team members on policies, procedures, and digital tools to ensure compliance and operational efficiency.
- Qualified for Allwell Medicare Advantage Elite Agent program.
EDI Technical Support Analyst
Change Healthcare
Alpharetta
01.2008 - 03.2017
- Worked extensively with ANSI 837I/837P formats and revenue cycle workflows.
- Implemented and configured revenue cycle management software for providers.
- Created and maintained mapping setups for claim submission, acting as primary contact for Capario File Manager 835/837 to facilitate effective communication.
- Troubleshot claim errors and rejections across multiple electronic billing platforms, ensuring accurate claim submissions.
- Conducted software trainings and maintained detailed documentation of system changes and troubleshooting steps to support user proficiency.
- Obtained vendor ID certification for company, enhancing credibility.
Education
Associate of Applied Science - Health Information Technology
DeVry University
Chicago, ILSkills
- Epic & EHR Skills: Epic Hyperspace (Cadence & PB)
- Troubleshooting
- Implementation Support
- EDI Software Training
- Ticket Triage
- Training Support
- Medicare/Medicaid Claims
- Salesforce
- Microsoft Office Suite
- QNXT
- ANSI X12/5010
- HIPAA Compliance
- Basic SQL
- Claims Analysis
- Provider Relations
- AHIP
- Medicare Sales
- Final Expense Sales
Certification
- Google Project Management Certificate (Coursera)
- AHIP Medicare Certification
- Medical Coding Certification – A+ Coding Institute
- Life, Health & Accident License – America's Professor
Timeline
Claim Analyst III
Aetna / CVS Health
04.2025 - Current
Patient Success Lead
Walmart Health
02.2023 - 04.2025
Executive Team Lead
Oak Street Health
01.2021 - 02.2023
Medicare Advisor
Centene
01.2019 - 01.2021
Senior Benefits Consultant
Goshen Enterprise Marketing
03.2017 - 01.2019
EDI Technical Support Analyst
Change Healthcare
01.2008 - 03.2017
Associate of Applied Science - Health Information Technology
DeVry University