Alize Brown
Citrus Heights
Summary
Claims-focused healthcare professional with over five years in medical billing, claims resolution, and insurance verification. Expertise in analyzing denials, ensuring coding accuracy, and managing high-volume workflows to enhance reimbursement outcomes while upholding HIPAA compliance and payer guidelines.
Overview
7
7
years of professional experience
Work History
Billing Specialist
WellSpace Health
11.2025 - 06.2026
- Processed and submitted medical claims to Medicare, Medi-Cal, and commercial payers, ensuring accuracy and timely reimbursement
- Reviewed and validated claims for accuracy, ensuring correct ICD-10/ CPT coding and payer-specific compliance prior to submission
- Investigated and resolved denied or underpaid claims by analyzing EOBs/ ERAs and coordinating with payers
- Posted payments, adjustments, and reconciled accounts to maintain accurate A/ R balances
- Monitored A/R aging reports and followed up on outstanding claims, facilitating timely reimbursements
- Utilized Epic and payer portals (including Availity) to manage claims and resolve billing issues effectively
- Ensured compliance with HIPAA and payer regulations while handling sensitive patient and billing data
Referral Specialist
Centene
10.2021 - 02.2025
- Processed over 60 referral and authorization requests daily, ensuring timely access to care in a high-volume
- Located appropriate servicing providers based on information provided on physician referral and patient location
- Maintained effective communication with providers and internal teams to stay updated on evolving processes
- Verified proper authorization status from primary care providers for each episode of care
- Maintained high productivity and accuracy while communicating effectively in a remote work setting
Claims Compliance Auditor
Wittman Enterprises
03.2019 - 08.2021
- Maintained compliance with federal and payer guidelines in all claims-related activities
- Investigated denied and underpaid claims to identify discrepancies and facilitate resolution
- Analyzed denial trends to enhance billing accuracy and minimize errors
- Collaborated with internal teams and payers to resolve complex claim issues
- Managed high-volume calls to assist patients and providers with billing and insurance inquiries
- Collected patient payments, maintained accurate account records, and processed write-offs in compliance with company policies
Education
High School Diploma -
Center High School
Antelope, CA05-2016
Skills
- Claims Processing & Adjudication
- ICD-10 & CPT Coding
- Denial Management & Resolution
- Insurance Verification (Medicare, Medi-Cal, Commercial)
- Accounts Receivable & Aging Reports
- Regulatory Compliance (HIPAA)
- EHR/EMR Systems (Epic)
- Insurance Portals & Clearinghouses
- Microsoft Office Suite
Timeline
Billing Specialist
WellSpace Health
11.2025 - 06.2026
Referral Specialist
Centene
10.2021 - 02.2025
Claims Compliance Auditor
Wittman Enterprises
03.2019 - 08.2021
High School Diploma -
Center High School