Summary
Overview
Work History
Education
Skills
Additional Information
Certification
Timeline
Generic

Brittney M. Lowe

Louisville

Summary

Dynamic Payment Integrity Specialist at Molina Healthcare with a proven track record in claims processing and a strong understanding of HCPCS and ICD coding. Recognized for exceptional communication skills and a commitment to process improvements, ensuring accurate and efficient resolution of payment discrepancies while enhancing client satisfaction. Payment Integrity Specialist with expertise in claims processing and in-depth knowledge of HCPCS and ICD coding. Recognized for enhancing client satisfaction and effectively resolving payment discrepancies through a commitment to continual process improvements.

Overview

14
14
years of professional experience
1
1
Certification

Work History

CTM Associate Specialist, Appeals & Grievances

Molina Healthcare
Louisville
10.2025 - Current
  • Coordinated patient-provider communication to enhance understanding and care continuity.
  • Managed patient enrollment processes for healthcare programs and services.
  • Resolved patient inquiries to facilitate timely access to necessary healthcare resources.
  • Developed educational materials for patient outreach initiatives to improve health literacy.
  • Analyzed data on past purchases, returns, discounts and payment history to identify opportunities for improvement.

Payment integrety specialist

Molina Healthcare
Louisville
02.2024 - 10.2025
  • Executed day-to-day duties with accuracy to ensure operational effectiveness.
  • Ensure correct DRG codes are utilized in the claims.
  • Coordinated with vendors to resolve payment discrepancies, enhancing payment accuracy.
  • Issued payment checks to providers for outstanding invoices.
  • Managed dual claims to support timely reimbursement efforts.

Resolved BOT errors to maintain system integrity.

Utilized various software and tools to streamline processes and optimize performance.

  • Prioritized and organized tasks to efficiently accomplish service goals.
  • Post refunds, providers have sent in.

Claims Adjudicator

Molina Healthcare
01.2023 - 02.2024
  • Investigated high volume of insurance claims to determine validity and coverage eligibility.
  • Assessed claim status and negotiated settlements or denials effectively.
  • Processed claims efficiently, contributing to revenue generation.
  • Prepared and presented claims to other insurers, collaborating to obtain information for resolution.
  • Communicated with clients to explain policy coverage and regulations.
  • Collaborated with team members and management to meet goals.

Admissions /Intake Coordinator

Kindred
05.2020 - 12.2023
  • Communicated with referral sources, physicians, and associated staff to check documentation for proper signatures.
  • Organized paperwork such as charts and reports for office and patient needs.
  • Answered phone calls and provided new clients with required paperwork to initiate service.
  • Entered referrals into appropriate system based on type of referral obtained.
  • Liaised between clients and healthcare providers to maintain continuity of care.
  • Attended case reviews and provided feedback on client progress.
  • Explained eligibility requirements, application details, payment methods, and applicants' legal rights during intake assessment.
  • Assessed clients' needs and determined eligibility for intake services.
  • Documented patient medical information, case histories, and insurance details to facilitate smooth appointments and payment processing.

Patient Access rep

Jewish Hospital ER dept Louisville
08.2019 - 05.2022
  • Ky 40202
  • Demonstrates a positive and professional attitude while providing excellent customer service skills -Answer all incoming calls with exceptional customer service with a focus on compassionate patient centered care -Review incoming website appointment requests and handle in a concierge style manner by acting as one point of contact for our patients in scheduling appointments across the organization in a timely manner -Schedule new, return, internal employee, and referring provider VIP appointments within multiple groups -Accurately schedule patient appointments in accordance with physicians’ template and guidelines using access center technologies -Regularly monitor guided schedule documents to ensure up to date scheduling compliance -Determine appropriate physicians for all non-directed referrals
  • Use Allscripts, Centricity Business, online paging systems as well as retrieve information from other hospital systems
  • Treat all matters confidentially concerning patient information according to HIPAA guidelines
  • Adhere to group productivity and quality metrics
  • Other duties as assigned.
  • Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
  • Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
  • Stayed calm under pressure to and successfully dealt with difficult situations.
  • Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
  • Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.

Case Manager III/Pharmacy Technician

CVS Health
12.2016 - 08.2019
  • Demonstrates a positive and professional attitude while providing leadership skills
  • Verifies Insurance
  • Follow up with patients and doctors
  • Providing great customer service
  • Using sympathy and Empathy when needed
  • Documenting every call
  • Assisted with billing
  • Created weekly detailed spreadsheets to keep up with inventory
  • Call insurance companies to follow up on prior authorizations and precertifications
  • Data Entry
  • Researched ICD9/10 codes as well has Hcpcs codes
  • Register patients into the program
  • Assist with copay assistance
  • Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
  • Developed and implemented comprehensive case management plans to address client needs and goals.
  • Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
  • Collaborated with an interdisciplinary team to determine timely delivery of services.

Provider Services Representative

Anthem BCBS
01.2015 - 09.2015
  • Kentucky 40222
  • Demonstrates a positive and professional attitude while providing excellent customer service skills
  • Entering data insurance in to system
  • Assisted with billing and invoicing
  • Ability to manage multiple priorities
  • Explained coverage on policy
  • Researched ICD9/10 codes as well has Hcpcs codes
  • Demonstrates a positive and professional attitude while showcasing my skill to prioritize and meet deadlines
  • 40299
  • Assisted providers with customer’s oop max and co insurance
  • Following up with denials on insurance claims
  • Assisted with Preauthorization requests/ Pre-Certifications
  • Assisted with Billing
  • Researched ICD9/10 codes as well has Hcpcs codes
  • Responsible for meeting deadlines
  • Demonstrates a positive and professional attitude while providing excellent customer service
  • Responded proactively and positively to rapid change.
  • Educated customers about billing, payment processing and support policies and procedures.
  • Followed up with customers about resolved issues to maintain high standards of customer service.
  • Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
  • Investigated and resolved customer inquiries and complaints quickly.
  • Trained new personnel regarding company operations, policies and services.
  • Maintained up-to-date knowledge of product and service changes.

Administration Specialist

AIG Insurance
03.2013 - 01.2015

Customer Service Rep

AIG Insurance
07.2012 - 03.2013
  • Demonstrates a positive and professional attitude while providing excellent customer service
  • Assisted customers with payments, as well as solving any issue they may be experiencing
  • Entering Data into our system
  • Verifying insurance policy coverage
  • Processing invoices for billing matters
  • Alerting clients of any program updates and changes
  • Resolving any contract issues with available resources
  • Demonstrates a positive and professional attitude while providing excellent customer service
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Answered constant flow of customer calls with minimal wait times.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Updated account information to maintain customer records.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.

Medicare Enrollment Specialist

Humana
08.2012 - 11.2012
  • Demonstrates a positive and professional attitude while providing excellent customer service
  • Entering data insurance in to system
  • Assisted with billing and invoicing
  • Explained coverage on policy
  • Utilized multiple programs to fix errors.
  • Assisted clients with completion of applications and paperwork.
  • Communicated with people from various cultures and backgrounds on application process.
  • Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
  • Used computer-aided guidance packages such as skills assessment tools, career planners, psychometric tests and personal inventories to assist clients in determining strengths and weaknesses.

Education

Certificate - Medical Billing And Coding

DeVry University
10-2026

General

Western High School
Louisville, Kentucky
05-2008

Skills

  • SKILLS AND QUALIFICTIONS
  • Excellent Computer Skills
  • Proficient in Microsoft Excel and Microsoft word
  • Proficient in meeting deadlines
  • Great communication Skills
  • Professional demeanor and attention to detail
  • Proficient in understanding claims
  • Qualified Data Entry specialist
  • Diligent in Process Improvements
  • Knowledge of HCPCS, CPT and ICD- Coding
  • Pharmacy Tech License
  • Use of Epic system, Cerner, salesforce, Allscripts
  • CMS Guidelines
  • Medical Billing and Coding
  • Review Cases
  • Critical Thinking
  • Claims processing
  • Medical coding

Additional Information

Pharmacy Tech

Certification

  • pharmacy tech

Timeline

CTM Associate Specialist, Appeals & Grievances

Molina Healthcare
10.2025 - Current

Payment integrety specialist

Molina Healthcare
02.2024 - 10.2025

Claims Adjudicator

Molina Healthcare
01.2023 - 02.2024

Admissions /Intake Coordinator

Kindred
05.2020 - 12.2023

Patient Access rep

Jewish Hospital ER dept Louisville
08.2019 - 05.2022

Case Manager III/Pharmacy Technician

CVS Health
12.2016 - 08.2019

Provider Services Representative

Anthem BCBS
01.2015 - 09.2015

Administration Specialist

AIG Insurance
03.2013 - 01.2015

Medicare Enrollment Specialist

Humana
08.2012 - 11.2012

Customer Service Rep

AIG Insurance
07.2012 - 03.2013

Certificate - Medical Billing And Coding

DeVry University

General

Western High School
Brittney M. Lowe