Brenda Perez, Cpht Email & Phone Number

South Gate, Ca, Us

Los Angeles, California, United States

Cypress, California, United States

Cypress, California, United States

Subject matter expert on claims configuration, successfully identifying and resolving claims issues. Skilled in collaborating with various businesses to implement mitigating processes to prevent further claims disputesPerform root cause analysis to correct system configuration issues and apply preventative measures to reduce risk of future issuesResolve 50% of claims issues within 11 business days or less, staying under the 30-business day average goalMove 98% of inquiries into action within 10 business days of receipt, exceeding the 95% goalAssist in document exchange with legal team for arbitration cases to support depositionsLead collaborative meetings with Washington and Southern California marketsResolve complaints from CMS within 10 business days or less to meet CMS compliance

Cypress, California, United States

Analyzed audit data results to identify process improvement opportunities, trained new analysts, developed standard operating procedures (SOP’s), managed month end reporting, and maintained auditor production dataReduced month end reporting time by 50% by incorporating complex formulas and pivot tables into tracking filesTeam Subject Matter Expert, trained 30 new and current auditors in 11 different audit processes over four yearsManaged various special projects with 100% completion rate on all projectsAssisted in development of new audit process to mitigate risk of financial losses in millions due to improper benefits codingContributed to procedure updates, increasing accumulated audit accuracy by an average of four percent and audit efficiency by an average of 30% in six monthsAssisted development team in automation of audit process and reporting into Access database reducing auditing time by about 33% and eliminating time spent on copying and pasting audit tracking information

Cypress, California, United States

Audited multi-department client services teams for proper implementation of pharmacy benefits and business liaison for audit and client services teamsPrimary contact for client services businesses entrusted to relay updates and train auditors dailyCreated official onboarding checklist to streamline access requests and training schedules for new hires, reducing onboarding process time by 80%Supported consolidation of audit data for monthly review and analysis, reducing month end reporting time by about 66%Transformed and documented two high risk audit processes improving audit accuracy and error identification mitigating risks of substantial penaltiesAssisted in research and resolution on paid claims with adjudication discrepancies to justify overpayments of tens of thousands monthly

Costa Mesa, California, United States

Audited member and provider paper claims for proper adjudicationEnsured member and provider paper claims were processed and properly reimbursed per client benefit policies and regulations reducing financial impacts on membersCollaborated with audit management team in process improvement strategies leading to updates in SOP’s improving audit accuracyPerformed ad hoc root cause analysis to resolve escalated claims discrepancies with tight deadlines

Cypress, California, United States

Refilled specialty medication via mail order system for home deliveryHandled high cost specialty medication refills and treatment coordination for members and providers with an average handle time of four and a half minutesEnsured customer satisfaction by resolving benefit eligibility issues and order discrepancies saving members between 50 to 1,900 dollars monthlyRegistered new patients into mail order program and arranged disease management follow-ups increasing drug therapy adherence

Downey, California, United States

Aided customers with their home improvement needs, managed special orders for customers, and resolved escalated customer issues