Brittany Moore
AmeriHealth Caritas Louisiana
Baton Rouge
21
years of professional experience
Dynamic individual with hands-on experience and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals. Currently in pursuit of a highly rewarding career, seeking a job in a challenging and healthy work environment where I can utilize my skills and knowledge efficiently for organizational growth.
Work History
Provider Network Management Account Executive
4 Years 10 Months- Building and maintaining relationships with Providers
- Servicing Provider accounts for assigned regional area which includes single or multiple practices in single or multiple locations
- Conducting routine and targeted on-site and office visits to review performance data
- Handle Provider complaints, claims questions, and operational conflicts within compliance
- Provides training in enrollment, systems usage, and data review
- Updating and maintaining Provider data reports for State requested information
- Maintains knowledge of systems used for additions, deletions, and updates of accounts (Facets; PLM)
- Provides monthly Value-Based Provider meetings to include updates regarding monthly membership and fees
Credentialing Data Analyst
5 Years 5 Months- Preparing and maintaining reports for credentialing
- Validating federal and state guidelines are met when processing applications
- Maintain all records of applications and documents of application and verification
- Preparing and finalizing contractual agreements
- Updating systems for new Provider setup
- Validating and setting up Providers via system applications used for Provider Data upkeep
- Maintaining communication between Providers and plan regarding information to complete credentialing
- Manage credentialing intake of all potential new Providers joining network
- Creating and maintaining positive rapport between credentialing department and all departments involved in setup
- Project Management
- Developing project plans
- Managing communication with all parties involved with projects
- Managing project schedule and delivery
- Managing project conflicts and research of resolution
- Managing record keeping of all documentation and communication regarding projects
- Reporting project finding and resolution to all parties involved
Customer Service Manager
1 Year 6 Months- Supervises the activities of customer service staff
- Hire, coach, conduct performance reviews of staff
- Resolves patient/customer complaints
- Performs quality control checks
- Manage routing of technicians
- Performs quality control checks
- Backup for customer service
- Assist with billing queries and consistent patient count
- Plan and implement new activities and products for better customer service
- Ensures consistency, productive, professional communication between staff with other branches
Receptionist
1 Year 10 Months- Answer phones
- Data Entry
- Mail bills
- Print and mail monthly shout out cards, birthday cards, and anniversary cards
- Print and mail notices for training courses, Cultural Competency meetings, etc.
- Assist with special projects
- Reference verification of trainees
- Scanning and archiving
- Fundraising
- Filing court cases and volunteer files
- Volunteer monthly report entries
- Copying case files
- Typing progress notes per advocate supervisors’ request
- Background checks on prospective volunteers
Lead Provider Services Advisor
2 Years 6 Months- Provided customer services to Doctor’s offices, hospitals, clinics, home health agencies, durable medical equipment companies, etc.
- Advised, analyzed, and solved claims issues
- Assisted with provider payments, member insurance benefits, authorizations
- Created documents for members and providers including claims processing solutions, inquiry information, additional information requests, other insurance coverage information, etc.
- Assisted with supervisor complaints, training, provider spreadsheets, and department training manuals.
- Assisted representatives with questions on provider inquiries
- Assisted supervisors in researching systems information for upgrade
- Collaborated with supervisors on developmental training
- Data entry of provider and member information
Customer Service Representative
2 Years 5 Months- Data entry of loan applications
- Provided customer service to potential loan applicants
- Assisted with payment arrangements and status of mortgage loans
- Aided with training customer service representatives
Education
- Business Management
January 2013-2015
Skills
Client relationship building
Account management
Relationship building and management
Pipeline management
Other Experience
Word, Excel, QuickBooks, 10-Key. Ability and willingness to learn and execute new enhancements. Rapid training skills, leadership skills, knowledge of CPT; fast-paced independent worker
Timeline
Provider Network Management Account Executive
AmeriHealth Caritas Louisiana
10.2021 - CurrentRead More
Credentialing Data Analyst
AmeriHealth Caritas Louisiana
05.2016 - 10.2021Read More
Customer Service Manager
Solace Medical
07.2013 - 01.2015Read More
Receptionist
Capital Area CASA Association
08.2011 - 06.2013Read More
Lead Provider Services Advisor
BlueCross BlueShield of La
09.2007 - 03.2010Read More
Customer Service Representative
Aegis Lending Corporation
03.2005 - 08.2007Read More
University of Phoenix
from Business Management
Read More