Courtney Burnes
Saint Peters
Summary
Quality assurance specialist with extensive experience in interpreting and implementing standards. Proven ability to address customer complaints and resolve non-conformance issues effectively. Strong analytical and problem-solving skills contribute to enhanced business processes and efficiency improvements. Track record of success in fast-paced environments, demonstrating attention to detail and a proactive approach to workflow optimization.
Overview
26
26
years of professional experience
Work History
Coding Analytics Specialist II
Centene Corporation
Chesterfield
10.2017 - Current
- Accept/reject clinical coding recommendations based on provider documentation, administrative policies, regulatory codes, legislative directives, or other guidelines to perform analysis of provider billing against Current Procedural Terminology (CPT) coding logic and rules.
- Administrative policies, regulatory codes, legislative directives, precedent or other guidelines under the guidance of senior team members or management.
- Compare provider billing and code auditing recommendations based on regulatory (Current Procedural Terminology) coding logic and state, CMS and NCCI guidelines and rules.
- Investigate and process appeals and adjustments for claims denied in code editing software systems.
- Maintain appropriate records, files and documentation.
- Finalize reimbursements based upon audit findings.
- Assist with research of health plan coding questions.
- Maintain appropriate records, files, and documentation in order to comply with the company’s Policy.
Sales Associate
Bath and Body Works, Limited Brands
Creve Coeur
10.2024 - 05.2025
- Assisted customers with product selection and provided personalized recommendations.
- Maintained store presentation by organizing merchandise and ensuring cleanliness.
- Collaborated with team members to create a welcoming shopping environment.
- Resolved customer inquiries and addressed concerns to enhance satisfaction.
- Educated customers on product features, ingredients, and benefits effectively.
- Participated in inventory management by restocking shelves and conducting audits.
- Supported promotional events by setting up displays and engaging with customers.
- Helped customers find specific products, answered questions, and offered product advice.
- Greeted customers and provided exceptional customer service.
- Performed cashier duties such as accepting payments, issuing receipts and counting money back change.
- Answered incoming telephone calls to provide store, products and services information.
- Worked with fellow sales team members to achieve group targets.
- Maintained cleanliness of store environment including floors, windows, displays.
- Restocked shelves as needed to ensure sufficient inventory levels.
Sales Associate
Bath and Body Works
St. Peters
10.2016 - 12.2017
- Greet customers, responding to questions, improving engagement with merchandise and providing outstanding customer service.
- Operating cash registers and manage financial transactions.
- Achieve established daily goals.
- Directing customers to merchandise within the store.
- Introduce promotions and opportunities to customers.
- Assist with floor set execution, window changes, visual presentation and marketing placement as needed.
- Support product replenishment activities that keep the store full and abundant.
Claims Specialist
Magellan Health Services
Maryland Heights
01.2012 - 10.2017
- Adjudicate claims and adjustments.
- Resolve claims edits and suspended claims.
- Maintain and update required reference materials to adjudicate claims.
- Provide backup support to other team/group members in the performance of job duties as assigned.
- Process HCFA and UB claim forms.
- Complete projects consisting of adjustments and perform root cause analysis.
Data Entry Specialist
Kelly Services
St. Louis
12.2010 - 12.2011
- Responsible for inputting client records into the system.
- Correct client records and update data.
- Maintain client records daily.
Patient Account Representative
St. Johns Mercy
St. Louis
09.2009 - 11.2010
- Responsible for inputting data from daily reports.
- Correct errors on patient claims.
- Verify patient eligibility.
- Re-bill claims for Medicaid and Medicare claims.
Claims Specialist
Express Scripts
Maryland Heights
12.2004 - 09.2009
- Input claim requests into adjudication platform maintaining compliance.
- Recognize and escalate appropriate system crisis and problems.
- Identifying claims requiring additional research.
- Recognize repetitive problems or issues and escalate as needed.
Customer Service Call Center Agent
Western Union
Bridgeton
11.1999 - 12.2004
- Resolve customer inquiries, and promote Western Union services.
- Inbound and outbound calls.
- Facilitate the money transfer processes.
- Provide first-level support for customer complaints.
- Document and escalate issues to the relevant department.
- Perform special projects, and other duties as directed by the team leader or manager.
Education
Bachelor of Science - Business Management
Western Governors University
Salt Lake City, UT05-2027
Skills
- Confidentiality maintenance
- Program learning
- Proactivity
- Multi-tasking
- Microsoft Office Suite
- Excel proficiency
- Facets software
- Amisys system
- Xcelys platform
- McKesson software
- Medical billing and coding
- AS400 system
- Citrix application
- Cenpas software
- Medical terminology expertise
- CPT coding analysis
- ICD-9-CM knowledge
- ICD-10-CM knowledge
- VLOOKUP function
- Customer service excellence
- Team collaboration skills
- Regulatory compliance expertise
- Coding standards adherence
- Effective communication skills
- Continuous improvement strategies
Computer Skillset
- Microsoft Office
- Excel
- Facets
- Amisys
- Xcelys
- McKesson
- Medical Billing & Coding
- AS400
- Citrix
- Cenpas
- Proficient in medical terminology
- CPT coding analysis
- ICD9-CM
- ICD-10CM
- Vlookup
References
References available upon request.
Timeline
Sales Associate
Bath and Body Works, Limited Brands
10.2024 - 05.2025
Coding Analytics Specialist II
Centene Corporation
10.2017 - Current
Sales Associate
Bath and Body Works
10.2016 - 12.2017
Claims Specialist
Magellan Health Services
01.2012 - 10.2017
Data Entry Specialist
Kelly Services
12.2010 - 12.2011
Patient Account Representative
St. Johns Mercy
09.2009 - 11.2010
Claims Specialist
Express Scripts
12.2004 - 09.2009
Customer Service Call Center Agent
Western Union
11.1999 - 12.2004
Bachelor of Science - Business Management
Western Governors University
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