Deborah Brosnan
Letterkenny,Ireland
Summary
Certified Professional Coder with extensive experience and knowledge in UHC systems, including COSMOS, CPA, IBAGG DOC360, HSR, NICE, GPS, and FileNet Imaging. Proficient in using ENCODER PRO and CES editor. Holds M&R 1,2,3 Certifications (2019-2021) and a Certified Professional Coder certification (2022). Seeking to leverage expertise in coding and system management to contribute effectively to a dynamic healthcare organisation.
Overview
22
22
years of professional experience
2
2
years of post-secondary education
Work History
Senior business analyst
Carelon Global Solutions Ireland
Limerick, Ireland
05.2024 - Current
- Led cross-functional team to successful project completion.
- Identified areas of improvement in current Commercial edits to enhance savings through detailed data analysis contributing to yearly target savings.
- Reviewed regulatory compliance practices ensuring adherence to industry standards.
- Coordinated training sessions on CPC, and coding guidelines for increased staff competency levels.
Claims Business Process Consultant
UnitedHealth Group
Letterkenny, County Donegal
03.2019 - 05.2024
- Support the expansion of the Business Partner process for Government Operations
- Identify and provide oversight of all key Business Partners which are Government Operations impacting.
- Identify/analyze potential solution approaches for project initiatives when required.
- Identify/analyze those potential solutions as it impacts claims business processes (e.g., process simplification, auto-adjudication, quality improvement, processing accuracy). Ensuring the necessary Operational Impact Assessment are considered and actioned.
- Assist in managing delivery of readiness plans for Government Operations.
- Provide necessary research when required on coding and regulatory adherence guidance.
- Partner with applicable stakeholders to drive effective implementation of solutions/process changes.
- Assist is Public Health Events process to monitor & provide direction for require implementations.
Claims Business Process Consultant
UnitedHealth Group
Letterkenny, County Donegal
03.2016 - 03.2019
- Assess and interpret customer needs and requirements. Research analysis on CMS documentation ensuring accuracy for Claims platforms.
- Assisting in CMS and financial audits.
- Reviewing CMS transmittals translating concepts into practice for claims platforms.
- Reviewing CMS complaints, Provider and Member complaints. Ensuring corrections are made to policies or systems if required. Providing education to Provider Advocates to address with providers.
- Summarizing complaints and issues at high level to present to senior leadership.
- Mentoring the DMR (Direct Member Reimbursement) teams. This included education on correct coding, CMS pricing and carrier pricing
Claims Business Process Consultant
UnitedHealth Group
Letterkenny, County Donegal
01.2012 - 03.2016
- Support for Claims queries on the M&R SharePoint.
- Research analysis on CMS documentation ensuring accuracy across both platforms for CES edits.
- Support for CES system updates and deployments. *Identifying and extracting claims data via excel to submit for rework projects due to CES data updates.
- System testing for new deployments.
- Policy ownership
- Support and lead for CES Data entry process for claims platforms
- Training
Claims SME Team Lead
UnitedHealth Group
Letterkenny, County Donegal
07.2003 - 01.2012
- Meeting daily/Weekly Quality and processing goals
- Daily support for a team of 17 claims Examiners.
- SME of various claim types and processes for different regions.
- Creation and updating of online documentation.
- Training and up skilling experienced examiners.
- Liaise with US teams via email and conference calls.
- Worked on CMS audits with the on-site Manager.
- Training and coaching.
Education
Certified Professional Coder - HealthCare Industry Standards
AAPC
USA 06.2021 - 10.2023
Skills
- M&R 1,2,3 Certifications 2019-2021
- Certified Professional Coder 2022
Experience and Knowledge on the following UHC systems:
- COSMOS ,CPA , IBAGG DOC360, HSR
- NICE, GPS, FileNet Imaging
- ENCODER PRO, CES editor
Affiliations
- I love history and enjoy visiting historical UNESCO sites. I also enjoy the outdoors, walking and hiking.
Timeline
Senior business analyst
Carelon Global Solutions Ireland
05.2024 - Current
Certified Professional Coder - HealthCare Industry Standards
AAPC
06.2021 - 10.2023
Claims Business Process Consultant
UnitedHealth Group
03.2019 - 05.2024
Claims Business Process Consultant
UnitedHealth Group
03.2016 - 03.2019
Claims Business Process Consultant
UnitedHealth Group
01.2012 - 03.2016
Claims SME Team Lead
UnitedHealth Group
07.2003 - 01.2012
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