Brandy King Email & Phone Number

Wisconsin, United States

New York City Metropolitan Area

• Led weekly team meetings and huddles with a team of 10 Credentialing Coordinators, resulting in a 40% increase in productivity and a 25% decrease in processing time for credentialing files.
• Assisted in implementation of performance improvements plans, leading in accuracy and compliance with credentialing standards.
• Served as a proxy for Symplr/Contract Approvals, reviewing and approving Symplr contracting tool with a 95% accuracy rate and ensuing timely contract approvals.
• Conducted a quality program for staff and oversaw VNS Internal Audits processes annually, resulting in 97% compliance rating and identification of areas for process improvement.
• Reinforced policies and procedures (P&P) and desktop procedures to staff, resulting in a 20% increase in adherence to P&P and 15% reduction in errors.
• Maintained a Power BI Dashboard using SQL application, providing real-time data insights to support decision-making and resulting in a 30% improvement in data accuracy and reporting efficiency.

New York City Metropolitan Area

• Processed Medicare & MLTC claim adjustment effectively using Facets system resulting from external providers and vendors and internal inquiries in a timely manner increasing SLA score to 99.5%.
• Configured Facets system to correct member/provider information, provider contractual rates and HCPCS code updates.
• Validates DRG grouping and repricing outcomes presented by the claim processing vendor TMG within 30-day timeframe to improve provider satisfaction by 92%.
• Worked collaboratively alongside configuration dept to advise on additional configuration errors such as SNF rate updates, Hospital rate updates within Facets system to improve system configuration by 87%.
• Performed capacity planning and reporting for provider 1-10,000 claim count projects before 30-day SLA to contribute to 99.5 provider satisfaction score.
• Worked collectively with team members on development of process documentation.

Bronx, New York, United States

• Processed Hospital and professional ICD10-CD, HCPCS and CPT 4 codes claims for payment in Facets system.
• Reprocessed large amounts of claims over 150 to correct system denial errors and decrease errors by 40%.
• Mailed out upheld\overturned letters of provider disputes within 30-day policy expectancy timeframe.
• Reviewed provider contracts and communicated with Account Managers to inquire about provider contracts including procedure codes and unit pricing.
• Priced DRG hospital claims in Webstrat system to validate correct pricing for Hospital claims.
• Reviewed authorizations attached to claims to ensure 100% accuracy to ensure provider payout efficiency.

Greater New York City Area

• Adjudicated about 250 claims daily for all Providers MLTC & Medicare products in QNXT system.
• Communicated with third party insurance companies to address claims inquiries.
• Translated claim status and claim denials to providers.
• Spearheaded claim appeals to determine whether to uphold or overturn claim inquiries.
• Reviewed authorization to determine accuracy, analyzed COB, & verified enrollment in Care Compass, QNXT, and Case Trakker system for MLTC and Medicare claims.
• Reprocessed claim to correct edits or discrepancies providing an increase in payout to provider by 45%.

Greater New York City Area

• Assisted providers with Medicare & Medicare claim inquiry's including denials and payment amounts.
• Adjudicated claims in Facets & used Macess system to identify whether claims denied or paid correctly.
• Sent out EOP's to providers via Payspan system.
• Assisted Medicaid members with contacting providers about bills they received.
• Adhered to HIPAA guidelines while servicing members and providers.

14 Wall Street

• Assisted providers with Medicare & Medicare claim inquiry’s including denials and payment amounts
• Adjudicated claims in Facets & used Macess system to identify whether claims denied or paid correctly
• Sent out EOP’s to providers via Payspan system
• Assisted Medicaid members with contacting providers about bills they receive
• Adhered to HIPAA guidelines while servicing members and Providers

Associates Degree-Business Administration