Anne H. Brewer
Myrtle Beach
Summary
Dynamic professional with extensive experience in denials and appeals management, providing clear direction to teams on complex account resolutions. Proven track record of implementing corrective action plans that enhance performance and compliance, while fostering effective communication with stakeholders.
Overview
1
1
Certification
27
27
years of professional experience
Work History
Audit Team Lead for Audit and Coding
Knowtion Health
06.2021 - Current
- Directed team members on daily inventory management to ensure accuracy and compliance
- Provides clear direction to team members for maintaining client specific protocols and procedures
- Prepared corrective action plans for performance improvement
- Provides direction for complex denials to team members and management for resolution
- Trained new and existing employees on processes and protocols, improving team competency and performance
- Uses professional notation that is clear, concise, and comprehensive throughout the account resolution process
- Proactively communicates questions and concerns to leadership for resolution
- Retrieves and analyzes reports relating to inventory workflow
- Assisted management with ad hoc inventory initiatives and projects
- Raised challenging accounts to management for specialized review and intervention.
- Prepared client-facing responses to inquiries, enhancing client satisfaction and engagement
- Conducts interviews and is responsible for hiring new team members
- Disseminates information for KPI and OKI reporting to management
Supervisor, Payment Posting
The Addison Group
10.2020 - Current
- Posts unallocated payments to aged accounts
- Reviews correspondence files for routing to appropriate departments for posting
- Other duties as assigned per company needs
- Temp agency for QualDerm Partners
Government Audit and Denial Manager
Alamance Regional Medical Center/Cone Health
01.2015 - 05.2021
- Managed Government and Non-Government patient account audits and payment denials to ensure compliance and optimize revenue recovery.
- Tracked and monitored requests for records, maintaining current activity on each record to generate quality evaluation reports and provide actionable improvement recommendations.
- Works closely with Care Management, Revenue Cycle, Physicians and Health Information Management.
- Supervises Audit Appeals Nurse, Denial Coordinators, and Government Analysts.
- Formulated and submitted formal appeals to relevant entities to secure reimbursement and address payment denials.
Denial Audit Coordinator/Medicare Claims Representative Supervisor
Alamance Regional Medical Center
01.2012 - 01.2015
- Supervised Medicare claims reimbursement representatives.
- Oversaw a team of Medicare claims representatives to ensure accurate processing of claims.
- Tracked and monitored requests for records and denials, ensuring current status on each recovery and denial record to support quality evaluation reports and improvement recommendations.
- Reviewed denials for medical necessity and applied admission criteria per hospital policy.
- Formulated appeals and submitted them to the auditing agency.
- Understood and communicated complex issues and changes related to regulatory compliance and third-party reimbursement.
- Collaborated closely with care managers, patient financial services, and health information management to provide ongoing feedback.
- Monitored and documented regulatory updates, maintaining compliance with current laws across all operations.
Care Management-Care Coordinator
Alamance Regional Medical Center
08.2006 - 01.2012
- Facilitated patient hospitalization from preadmission through discharge, ensuring smooth transition to community or alternative care level.
- The Coordinator interfaces with physicians, nurses, social workers, and other healthcare team members to expedite medically appropriate cost-effective care.
- Applied clinical expertise and medical appropriateness criteria to optimize resource utilization and streamline admissions and discharge planning.
- Completed multidisciplinary assessment of needs, coordinated implementation of care plan, and monitored ongoing client and family needs to achieve care plan goals.
RN-Telemetry
Alamance Regional Medical Center
07.2005 - 08.2006
- Coordinated comprehensive care for adolescent, adult, and geriatric patients, ensuring adherence to NC Nurse Practice Act and hospital protocols.
- Which merged with Cone Health
- Monitored patient vital signs using telemetry equipment.
- Collaborated with medical team to assess patient conditions.
- Administered medications and provided patient education on treatments.
Medical Assistant/Clinical Coordinator
Karam Family Practice
Liberty
01.2000 - 06.2005
- Assisted in care of patients by assessing vital signs, obtaining electrocardiograms, administering injections, performing venipunctures, conducting pulmonary function tests, obtaining X-rays, maintaining laboratory records, and facilitating patient referrals.
- Coordinated clinical staff schedules to optimize staffing levels and enhance patient care.
- Ensured accurate vaccine records in Vaccines for Children Program to support patient health initiatives.
- Ordered vaccines and managed inventory levels to ensure adequate supply.
- Maintained up-to-date computer-based patient charts to ensure accurate patient information.
- Maintained drug screening records for outside vendors and communicated results to employers for compliance.
- Implementation of patient assistance program using materials from Rxassist and pharmaceutical representatives.
- Performing controls of laboratory equipment daily and reporting any problems to the lab director.
- Assisted Office Manager in ensuring compliance with CLIA regulations for laboratory practices.
Education
Bachelor of Science - Nursing
South University
Savannah, Ga01-2010
Associate Degree - Nursing
Alamance Community College
Graham, NC01-2005
Emergency Medical Technician-Paramedic -
Alamance Community College
Graham, NC01-1992
Skills
- Performance management
- Audit compliance
- Denial resolution
- Financial reporting
- Regulatory updates
- Revenue cycle management
Certification
Certified Case Manager, 01/01/09, 01/01/14
Academic Organizations
- Phi Theta Kappa, 2002
- South University Nursing Honor Society Charter Member, Phi Kappa Chapter, Sigma Theta Tau, 2010
Volunteer Experience
- Alamance Council of the Blind, 01/01/00, 12/31/15
- North Carolina Council of the Blind, 01/01/00, 12/31/15, Secretary of the Board of Directors, 01/01/09, 12/31/13, Scholarship Committee Chair, 01/01/13, 12/31/14
- American Council of the Blind, Life Member
Operating Systems
- Epic
- Allscripts
- Sunrise Clinical Manager
- Siemens
- Premier
- Mod Med
Work Related Requirements
- Leadership Academy-Cone Health, 01/01/16
- Resolute Hospital Billing-Epic, 01/01/16
Timeline
Audit Team Lead for Audit and Coding
Knowtion Health
06.2021 - Current
Supervisor, Payment Posting
The Addison Group
10.2020 - Current
Government Audit and Denial Manager
Alamance Regional Medical Center/Cone Health
01.2015 - 05.2021
Denial Audit Coordinator/Medicare Claims Representative Supervisor
Alamance Regional Medical Center
01.2012 - 01.2015
Care Management-Care Coordinator
Alamance Regional Medical Center
08.2006 - 01.2012
RN-Telemetry
Alamance Regional Medical Center
07.2005 - 08.2006
Medical Assistant/Clinical Coordinator
Karam Family Practice
01.2000 - 06.2005
Bachelor of Science - Nursing
South University
Associate Degree - Nursing
Alamance Community College
Emergency Medical Technician-Paramedic -
Alamance Community College