Brooke Hutchens
Mars
Summary
Dynamic Claims Operations Specialist with extensive experience at Wexford Health Sources, adept at claims analysis and processing. Proven problem-solver with a keen attention to detail, successfully resolving complex issues and enhancing operational efficiency. Skilled in medical coding and committed to delivering exceptional client service while maintaining confidentiality.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Claims Operations Specialist
Wexford Health Sources, Inc
03.2021 - Current
- Review and update system information to include eligibility, authorizations, payments, denials and resolve outstanding issues to meet client expectations,
- Function as team point for Optum software updates and managements.
- Process corrected claims to include retractions and underpayments.
- Tracking, review and determination of claims appeals and claims adjustments.
- Assist in review of claims system updates and related claims testing.
- Training and coaching team on relevant topics to include but not limited to medical coding, pricing and utilization of Optum software.
- Support Claims Administrative Assistant. Point of contact for training, procedural questions and escalated issues.
- Review and price Medicaid claims.
- Process paper claims including complex, high-dollar and specialty claims.
- Resolve simple and complex issues through established work processes.
- Identify and communicate opportunities for process improvement to management and co-workers.
- Deal professionally with confidential information.
- Report daily production.
- Assume other duties as assigned and directed.
Authorizations Claims and Coding Specialist
Wexford Health Sources, Inc
08.2019 - 03.2021
- Reviewed and updated authorizations for eligibility, date and provider claims information as required to meet client contract requirements.
- Provided medical coding support for the claims team.
- Reviewed and priced Medicaid claims.
- Processed claims from a range of providers including facility, professional, ambulance, dental and DME according to Medicare, Medicaid or contracted rate guidelines to meet client expectations.
- Dealt professionally with confidential information.
- Reported daily production.
- Other duties as assigned and directed.
Education
Certificate - Medical Billing And Coding
Pittsburgh Technical College
Pittsburgh, PA10-2018
Skills
- Claims analysis
- Claims processing
- Investigation techniques
- Problem-solving
- Time management
- Attention to detail
- Organizing and prioritizing work
- Multitasking
- Adaptability and flexibility
- Excellent communication
Accomplishments
Invited to present at AAPC chapter meetings in PA and NY on Billing and Coding in Correctional Healthcare.
Certification
CPC
Timeline
Claims Operations Specialist
Wexford Health Sources, Inc
03.2021 - Current
Authorizations Claims and Coding Specialist
Wexford Health Sources, Inc
08.2019 - 03.2021
Certificate - Medical Billing And Coding
Pittsburgh Technical College
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