Brooke J. Email & Phone Number

Denver, CO, US

Aurora, Colorado, United States

Colorado, United States

• Manage daily operations and activities of 34 overseas staff consisting of 7 departments for all United States A&C legacy business units.
• Created a cross training program, ensuring that staff members are able to perform confidently and effectively in all positions.
• Weekly auditing, generating monthly reports, creating documentation and KPI metrics for evaluation of staff progress.
• Applied effective strategies and led the implementation of improved nonbillable service codes across all venues reducing nonbillable service losses by $3,000,000.
• Reduced overseas labor cost by 25%.

Thornton, Colorado, United States

• Service Coordinator- Supervisor of CF and Authorizations
• Manage team overseas and stateside, training, created training documents and videos and creating KPI’s for evaluating staff progress.
• Review and analyze contract requirements to ensure completeness and note any compliance requirements
• Track and organize data for billing team, obtaining resolution on deferrals and obtaining any required documents or correspondence needed to ensure full reimbursement or services.
• Audit all converted appointments for clean payroll, audit all billable and non billable appointments maximizing contract fulfillment, along with ensuring contract compliance.
• Auditing, Trouble shooting and Identifying payroll errors

Bakersfield, California Area

• Creating, Auditing and maintaining all new and existing benefit plans, to optimize accuracy of authorizations and claims processing as well as minimize Member complaints.
• Interpreting and translating of Health Plan benefits to corresponding procedure codes (HCPC and CPT), including diagnosis codes when needed (ICD-10).
• Building Benefits Handbook, to ensure future accuracy of benefit plan building.
• Identifying and coding benefits requiring limitations and exclusions, building advanced rules when needed.
• Liaison between benefits department and all other departments, verifying member coverage for specific benefits and verifying copays for approved benefits.
• Contact health plans for benefit interpretations and clarifications for use of benefits for Member Service Benefit Administration.

Bakersfield, California Area

• Verifying and updating Member eligibility, demographics, Coordination of Benefits (COB) and Medicare Secondary Payor (MSP).
• Liaison between Members, Health Plans representatives and Providers.
• Maintained and created spreadsheets identifying eligibility issues, and resolutions; identifying affected claims and authorizations.
• Assisted with the Monthly Health Plan Inload files, verifying errors and ensuring the monthly eligibility from the Health Plans were added to the system EZ-cap.

Bakersfield, California Area

• Managing inventory, ensuring that work loads are organized and distributed timely to staff. Tracking six other department members daily, ensuring goals are met.
• Escalating issues with staff and inventory to Manager and Director, assisting in the developing process.
• Liaison between claims department and all other departments.
• Training new staff and current staff in all processes and procedures, adhering to company guidelines.
• Identifying trends and process improvement opportunities.
• Responsible for processing contracted and non-contracted professional senior and commercial claims within the guidelines of CMS and DMHC AB1455.

Bakersfield, California Area

• Responsible for overseeing and managing the reimbursement department business activities and operations when manager was not present.
• Supervised and assisted ten other department members and various other departments in the organization, fixing any day to day issues when necessary.
• Filtered all collections and billing questions, resolving issues and directing questions to Reimbursement Manager when necessary.
• Provided daily operational leadership, serving as a consultant to intake, pharmacy and delivery department.
• Autonomously identifying and resolving issues related to billing and collection accounts.
• Training new employees, skill assessments, instructing proper billing procedures and addressing complaints and resolving issues per Walgreens policies and procedures.

Thousand Oaks, CA

• Responsible for billing, timely filing, collections and appealing home infusion medical claims to health insurance companies and their affiliates.
• Accountable for analyzing and developing strategies to promote timely reimbursement of claims with an approximate monthly average A/R of three (3) million dollars.
• Billed out over 700 claims monthly on 1500 HCFA forms, both electronically and paper.
• Liaison between all departments; amending prescriptions and verifying shipments and deliveries, assisting with obtaining authorizations and insurance verification for billing purposes.
• Sent patient statements, arranged payment plans, loaded patients into collections agencies when necessary.
• Able to do insurance eligibility checks and check status of authorizations, both via phone and through insurance portals.

Data Analysis

Organic Chemistry

Associate'S Degree, General Studies