I’shere Brooks
Clarksville
Summary
Highly experienced healthcare professional with 20 years in Healthcare Professional, specializing in claims auditing, revenue recovery, Medicare and Medicaid compliance, and provider relationship management. Proven track record in resolving high-impact claims issues, managing payer-provider relations, and ensuring adherence to CMS and FDR regulatory standards. Recognized for driving process improvements, recouping millions in lost revenue, and serving as a trusted liaison between internal stakeholders and external providers. Experienced in working remotely for the past 10 years, demonstrating strong self-management, communication, and productivity in a virtual environment. Ready to bring deep industry knowledge and a data-driven mindset to Knowtion Health’s revenue optimization team.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Provider Analyst / Business Relationship Manager
Cigna HealthSpring
Nashville
06.2021 - Current
- Built and maintained strong working relationships with contracted providers to ensure smooth claims operations and issue resolution.
- Interpreted provider contracts and ensured claims were processed accurately per fee schedules and CMS guidelines.
- Analyzed recurring claims issues and drove resolution through process enhancements and training.
- Facilitated meetings with providers and internal stakeholders to address payment delays, contract clarifications, and denial trends.
Senior Recovery & Resolution Representative
Cigna HealthSpring
Baltimore
01.2020 - Current
- Led audit and resolution efforts for denied, underpaid, and improperly adjudicated claims across Medicare and Medicaid populations.
- Recovered an average of $3M annually through proactive identification of payment errors and resolution strategies.
- Ensured compliance with CMS and FDR requirements, working directly with delegated entities and external vendors.
- Acted as SME for complex claims issues, collaborating with internal legal, finance, and compliance teams.
- Provided detailed reports and insights to leadership, improving audit response times and resolution cycles by 35%.
Claims Auditor / Senior Claims Representative
Cigna HealthSpring
Baltimore
01.2009 - 01.2015
- Conducted post-payment audits of Medicare and Medicaid claims for accuracy and compliance.
- Identified trends in incorrect billing and educated providers and internal teams to prevent recurrence.
- Supported CMS audits and data validation processes for regulatory readiness.
- Ensured timely recovery and adjustment of overpaid claims in line with federal and state mandates.
Education
Associate of Science - Health Information Management (or related field)
CCBC
Baltimore, MDSkills
- Revenue Recovery & Claims Resolution
- Medicare & Medicaid Regulations (CMS Compliance)
- Claims Auditing & Payment Integrity
- FDR Compliance Oversight
- Provider Contract Analysis & Relationship Management
- Denials Management & Appeals
- Root Cause Analysis & Process Improvement
- Data Reconciliation & Reporting (Excel, Tableau)
- Cross-functional Collaboration
- RCM Systems: Facets, Epic, Cerner, SAP, etc
- Systems: Facets, QNXT, Epic, Cerner, SAP, RevElate
- Tools: Microsoft Excel (pivot tables, VLOOKUP), Tableau, Power BI
- Compliance: CMS Guidelines, HIPAA, FDR, Medicaid State Regulations
Websites
Certification
- Certified Revenue Cycle Specialist (CRCS) – AAHAM
- Certified Professional Coder (CPC) – AAPC
- CMS Medicare Compliance Certificate (Optional if applicable)
Timeline
Provider Analyst / Business Relationship Manager
Cigna HealthSpring
06.2021 - Current
Senior Recovery & Resolution Representative
Cigna HealthSpring
01.2020 - Current
Claims Auditor / Senior Claims Representative
Cigna HealthSpring
01.2009 - 01.2015
Associate of Science - Health Information Management (or related field)
CCBC