Brian Suiter Email & Phone Number

Kingsport, TN, US

Attend and engage in meetings on behalf of Provider Relations leadership. Organize education trainings every Friday for the Midsouth and Gulf States. Act as additional Manager support for the Midsouth Provider Relations Advocate Team

• Knowledgeable in health care products; HCP, CHP, FHP, Medicare and Claims codes; ICD-10-CM diagnosis Codes, CPT and HCPCS.
• Create end to end action plans for complex projects and outstanding issues for hospitals and physicians
• Conduct frequent, in-person focus visits with providers within assigned geographic region
• Support development and management of provider networks
• Build/nurture positive relationships between the health plan and providers
• Reviewing and researching provider claim issues. Root causing to identify if issues are contract related or processing issues(this is a primary function of this role)

• Investigate and analyze high volume medical claim project requests
• Perform root cause analysis, determine errors and make recommendations for correction
• Provide detailed explanation and outcome of medical claims projects to hospitals and individual physicians
• Developed reports within SQL database environment for the project management team to utilize as a more efficient process
• Developed training material for SQL based program and conducted training for project management staff
• Lead Subject Matter Expert on Large Scale projects for multiple Medicaid states. Developed the reporting tools, reviewed and audited large excel files in excess of 100k for quality assurance. Developed training.

Kingsport, TN

• Serve as on-site resource and technical expert for Custom Care Professionals in the operations site.
• Train/Mentor fellow Customer Care Professionals
• Analyze, Develop and review business support processes
• Responded to customer requests via correspondence including phone, email and mail to assist medical/behavioral providers and members with complex claim issues and health insurance policies and procedures.
• Maintain State reports regarding Customer Complaints on claim and benefit processing.
• Responsible for Quality Assurance of Call Center Complaints, Grievances, and Appeals reporting for the operations site

Kingsport, TN

• Respond to customer and provider request via correspondence including phone, email and mail to assist medical providers and members with claim status and health insurance policies and procedure.
• Answered an average of 85 calls daily.
• Constantly met and exceeded all company goals.
• Assist members and medical professionals with benefit resolution and claim denials