Don Brown, Mba Email & Phone Number

• Identify and analyze claims data within a Managed Care Plan.
• Proactive analytics to assist in quality monitoring on claims processed in the claims adjudication system.
• Provide feedback to department leadership for process improvement.
• Work with department analysts to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
• Perform audits to determine whether system controls were effective, efficient, and in compliance with all local, state and federal regulations; proactively identifying risks and issues and developing solutions.

Coral Gables, Florida, United States

• Team SME for HCFA HIPAA form data metrics and explanation of benefits (EOBs).
• Audits claims in search for underpayments in adherence to QA procedures.
• Interprets reasons for denials associated with medical claims needing senior level review.
• Liaison for direct communication with insurance providers to resolve claim discrepancies.
• Authors formal written communication detailing reasons for appeal in compliance with third party vendors.
• Manages appeals process from start to finish alignment with accounts receivable goals.

Sunrise, Florida, United States

• Analyzed GPMS contract account payment history to determine timing between collection of overdue payments /invoices.
• Communicated directly with external vendors (e.g. facility administrators, 3rd party providers and/or Pediatrix employees) to follow up on billing or collections while adhering to company guidelines.
• Documented clear and concise notes in GPMS contract accounts to assure appropriate ongoing follow-up and effective review by management.Effectively utilize billing and collection tools such as aging reports, queue.
• Executed quality control assessments for variable rate contract accounts (i.e. correct amounts were billed, payments were posted correctly, appropriate adjustments were made, etc.).
• Led account reconciliation project to identify new contracts with retroactive dates and/or rates.

Fort Lauderdale, Florida, United States

• Engaged with the leadership team on adherence to business maintenance best practices and general compliance measures at the branch location.
• Assisted compliance officer with local, state, and federal DME compliance measurements (i.e. Medicare/Medicaid conditions of participation, site visits, etc.)
• Co-facilitated site visits for accrediting bodies such as Medicare, Medicaid, Department of Health & Human Services.
• Adhered to compliance standards associated with HIPAA privacy regulations on a daily basis.
• Served as a liaison with other departments and outside agencies, including high-level staff.

Plantation, Florida, United States

• Handled end-to-end processes associated with claim data management.
• Identified and addressed issues impacting auto-adjudication levels and claim accuracy.
• Analyzed claims systems, provider set ups / contracts to process pended claims.
• Reviewed provider contracts, Single Case Agreements, Letters of Agreements to determine claims payments.

Miramar, FL

• Generated reports to capture deficiencies in processed claims prior to check run, which prevented $3,000 in daily loss revenue
• Managed directional guidance to improve the overall quality of individual examiners as last point of contact prior to payment being sent outbound
• Loaded new Provider Contract’s fee schedule in the system database and maintained updates as they are submitted by Provider Relations

Fort Lauderdale, Florida

• Engaged in analyzing and calculating medical reimbursements to ensure regulatory compliance.
• Served as the lead inpatient/outpatient physician and hospital claims representative.
• In charge of overpayment verifications based on patient & insurance prior to refunds.
• Served as a team player and contributor when involved in various department activities.
• Worked with various departments to improve inpatient workflows.
• Partnered with other departments regarding revenue integrity using Revenue Cycle Pro.

Coral Gables, FL

• Completed and cleared 45 medical claim reviews for UMHC and ABLEH/Sylvester Comprehensive Cancer Center daily.
• Navigated different ICD9/ICD10 coding and contracting projects, improving billing accuracy by 20%
• Served as a personal account representative to evaluate patient financial status and establish payment plans when appropriate

Miramar, FL

• Resolve claim denials for prescribed medication under Workers’ Compensation.
• Reviewed and resolved claim denials for prescribed medication under Workers’ Compensation.
• Verified the existence of litigation cases to show valid reasons for seeking payment for medication.
• Ensured patient information in the organization’s database was up to date and payment denials were cleared.
• Used ezDispense (Medical Billing System) to investigate and compare services rendered versus invoices paid.
• Served as a company leader and received various awards.

Miami, FL

• Managed and maintained 60 patient accounts and confirmed Medicaid and Medicare eligibility
• Clarified ambulatory charges to patients resulting in customer service rating improvement of 12%

Fort Lauderdale

• Upheld Mental Health Management and Department of Corrections policies and procedures by addressing the health care’s staff concerns or communicating issues to the appropriate party for resolution.
• Approved invoices for payment and ensured that charges were properly entered into the OBIS cost system.
• Authorized purchases and implemented perpetual inventory.
• Ensured that inmate requests and informal and formal grievances were answered.
• Executed decisions and delegate authority, while managing all levels of medical and administrative personnel.

Miramar, FL

• Responsible for patrol and supervision of Miramar Regional Park.
• Assigned and managed pavilions.
• Responded to park concerns and questions concerning recreation facility programs and policies.
• Enforced rules and regulations of the City of Miramar Parks and Recreation.
• Investigated complaints, crime, and trespass/encroachment and injury accidents.
• Performed minor maintenance work on equipment and facilities.

Pembroke Pines, FL

Collect fees for entrance to the facility, tennis courts, waterpark, distribute numbered bands, assist with group and boat rental contracts, assist visitors with questions, assist with concession stand sales, promote the park and its recreational activities.

Broward General Medical Center Fort Lauderdale, FL

• Maintained documents, personnel files, and prepared new hire/termination paperwork.
• Created files for record requests and updated the request log.
• Daily processing of Verification of Employment requests

Miramar, FL(FXE) / FLL Ramp

Unload Bulk trucks, load freight from trucks and aircraft containers onto conveyer belts, check, sort and clear front desk for packages. Scan freight and reload into outgoing containers. Check work area for anything overlooked.

Doral, FL

Assist with the implementation by updating and re-labeling the entire Corporate Tax department's paper file system and tax law library into the new electronic records management file system (FileSurf)

Pembroke Pines, Florida

Data collection for market research. Pembroke Lakes Mall shoppers were randomly selected and paid to voice their opinions on products and services they use. Surveys covered everything from cars to hospital care.Conducted surveys to screen respondents to ensure compliance with qualifications for compensation. Reviewed applications. Provided appropriate.

Master Of Business Administration (Mba), Management

Applied Technology Diploma, Medical Billing & Coding

Bachelor Of Health Services, Health/Health Care Administration/Management

Associate Of Arts (A.A.), Business Administration And Management, General

Certificate, Project Management

Certificate, Property Management