Whitney Brian is seeking a position that utilizes communication and interpersonal skills. He has a Bachelor's degree in Human Services from Touro College. Brian has over 10 years of experience in customer service roles within the healthcare industry, including at Emblem Health and HealthPlus Amerigroup. His experience includes authorizing services, handling customer inquiries, training staff, and making process changes to improve customer satisfaction. He is skilled in areas such as government relations, claims processing, cultural awareness, and Microsoft Office applications.

1. WHITNEY BRIAN
410 St. Nicholas avenue apt 16G, New York, NY 10027 | H: 646-234-9738 | tds417@gmail.com
Professional Summary
To obtain a position that willallow me to utilize my vast work experiences, communication,
and interpersonalskills effectively.
Education and Training
Bachelors of Science, Human Services June 2015
Touro College -New York, NY
Human Services
Skill Highlights
Government relations knowledge Staff trainingand development
Patient-oriented In-depth claims knowledge
Personaland professionalintegrity Culturalawareness and sensitivity
ICD-9 codes/ICD-10 Codes High customer service standards
Microsoft Word Customer service management
Microsoft Excel expertise
Microsoft PowerPoint Relationship and team building
Microsoft Outlook
Professional Experience
MLTC-Care Specialist Feb 2014to Current
Emblem Health - New York, NY
Collect customer feedback, make and process changes to exceed customer
satisfaction goals.
Provide accurate and appropriate information in response to customer inquiries.
Work with upper management to ensure appropriate changes were made to improve
customer satisfaction.
Make reasonable procedure exceptions to accommodate unusualcustomer requests.
Process and review authorizations for patients: DME,Personalcare service,
Transportation request, Physicaltherapy,Nursing Service, Speech and Occupational
Therapy, Skilled Nursing Inpatient.
Review members assessment cases from the UAS system to input in data system.
Handle incomingand out bound phone calls via callcenter
Record and file patient data and medicalrecords.
Strictly follow allfederaland state guidelines for release of information.
Assist nurses with patient care plans,including assessments, evaluations,and nursing
diagnoses.
Train new hires.
Perform claim status review and reprocess claims.
Follow the Medicaid and Medicare guidelines to authorize services.
Service Coordinator Oct 2011 to Oct 2012
HEALTHPLUS AMERIGROUP - Brooklyn,New York
Collected customer feedback and made process changes to exceed customer
satisfaction goals.
Ran reports and supplied data to fulfillcustomer report requirements. Developed
effective relationships with allcall center departments through clear communication.

2. Trained staff on how to improve customer interactions.
Handled a market of customers within 13 States
Medicalmanagement liaison between providers and medicaldirector
Authorized emergent inpatient admissions, prenatalcare, minor outpatient surgeries,
MRI, Durable medicalequipment
Collected customer feedback and made process changes to exceed customer
satisfaction goals.
Made reasonable procedure exceptions to accommodate unusualcustomer requests.
Addressed customer service inquiries in a timely and accurate fashion.
Performed claim status review and reprocessing claims.
Followed the Medicaid guidelines and insurance policies to authorize procedures,
surgeries etc.
Office Manager May 2010 to Jun 2011
Multi-Specialty Center at Maimonides - Brooklyn,New York
Created trainingmanuals targeted at resolving even the most difficult customer
issues.
Successfully managed the activities offour team members in one location.
Assisted with schedulingdoctor’s appointment.
Managed payrolland time and attendance systems.
Responded to employee inquiries regarding payrolland timekeeping.
Supported patients with customized patient teachingtools.
Delegated staff duties.
Prepared for HIPAA and JCAHO reviews,ensuring required brochures and pamphlets
were available to patients in allclinics.
Organized,updated and maintained over 200 patient charts.
Recorded patients'medicalhistory,vitalstatistics and test results in medicalrecords.
Provider/Member Customer Service Coordinator Aug 2003 to Dec 2009
US FAMILY HEALTH PLAN- ST. VINCENT'S CATHOLIC MEDICALCENTER -New York,NY
Collected customer feedback and made process changes to exceed customer
satisfaction goals.
Demonstrated mastery of customer service callscript within specified time frames.
Facilitated information flow between customer service, account management
operations, qualityassurance, trainingand payrolldepartments to guarantee call
center objectives were met.
Properly directed inbound calls in phone queues to improve callflow.
Led a team of customer service representatives to increase service center
profitability.
Designed manuals for trainingnew hires.
Trained new hires using manual.
Performed claim status review and reprocessing claims.
Created spreadsheets utilizingExcelto complete claim status for multiple providers,
hospitals.
Gave presentations on effectiveness of great customer service.
Skills
Experienced in customer service and callcenter duties
Experience in Manage Long Term Care policies
Educated in Medicare and Medicaid guidelines
Experienced in Utilization Management
Educated in the ICD9 and ICD10 codes
Certified in Substance Abuse & MentalHealth
Certified in Child Abuse and Maltreatment
Certified in Domestic Violence Prevention