Breahna Hughes

Led cross-functional training initiatives for Meditech Expanse platform rollouts, ensuring consistent adoption across multiple facilities. Collaborated with corporate, division, and facility leadership to align implementation plans with strategic business objectives. Developed, refined, and delivered training materials, improving knowledge retention and user performance.

Expanse Associate Trainer - HCA Healthcare

(2024-04 - 2025-06)

• Led cross-functional training initiatives for Meditech Expanse platform rollouts, ensuring consistent adoption across multiple facilities.
• Collaborated with corporate, division, and facility leadership to align implementation plans with strategic business objectives.
• Developed, refined, and delivered training materials, improving knowledge retention and user performance.
• Identified functional gaps, recommended system enhancements, and partnered with stakeholders to optimize workflows.

Referral Specialist I - myNEXUS

(2022-01 - 2023-08)

• Managed high-volume referral workflows, ensuring accuracy, compliance, and timely service delivery.
• Acted as the primary liaison among hospitals, physicians, vendors, and patients to resolve complex service issues.
• Implemented process improvements that reduced turnaround times and improved stakeholder satisfaction.
• Monitored referral queues and proactively escalated urgent requests to ensure timely patient care coordination.
• Verified insurance coverage and prior authorization requirements, reducing service delays and preventing claim denials.

Medical Receptionist - Vanderbilt University Medical Center

(2021-08 - 2021-12)

• Coordinated daily patient scheduling and order processing for a high-volume medical unit, improving service efficiency.
• Acted as a key communication link between patients, families, and clinical teams to ensure smooth care transitions.
• Maintained and updated operational logs and documentation to support quality and compliance standards.
• Proactively identified scheduling conflicts and implemented adjustments to minimize delays in patient care.
• Assisted leadership with workflow planning to optimize clinic resources and staffing coverage.

Claims Examiner I - Disability Determination Services

(2021-02 - 2021-07)

• Managed a caseload of disability claims, ensuring timely and accurate eligibility determinations.
• Coordinated with physicians, specialists, and claimants to collect and analyze critical medical and employment documentation.
• Led end-to-end case review processes, from initial intake through final written decision, ensuring compliance with federal and state regulations.
• Identified process bottlenecks and worked with peers to improve efficiency in document review and case handling.
• Provided subject matter expertise to peers on case documentation best practices, contributing to team training efforts.

Member/Provider Enrollment Representative - Cigna-HealthSpring - Nashville, TN

(2017-01 - 2020-12)

• Served as the primary contact for prospective and current members, answered questions via phone or email regarding program options, benefits, eligibility, and procedures.
• Guided members through the application process, ensuring all required documentation and forms are completed accurately and correctly.
• Accurately entered and updated member information into databases or CRM systems and maintained meticulous digital records.
• Investigated and resolved any enrollment issues, discrepancies, or setbacks (e.g., incomplete applications, eligibility denials), escalating complex cases when necessary.
• Ensured all enrollment activities, documentation, and data handling comply with relevant policies and regulations (e.g., HIPAA in healthcare, FERPA in education).
• Conducted proactive follow-up with applicants to track enrollment progress, gather missing information, and ensure a timely and smooth process.
• Clearly explained program guidelines, coverage options, and procedures to members, ensuring they understood their benefits and responsibilities.
• Created eligibility lists and reports to track enrollment statistics and progress for management and other departments.
• Prepared, reviewed, and submitted initial enrollment and re-enrollment applications to various government and commercial payers.
• Coordinated and collected necessary documentation from providers, such as medical degrees, state licenses, DEA numbers, board certifications, CVs, and liability insurance information.
• Ensured all application information is accurate and complete and that providers meet all compliance and regulatory standards, including primary source verification of credentials.
• Monitored the status of applications with insurance carriers and conducting consistent follow-up to expedite the process and obtain provider numbers (payer IDs).
• Accurately entered and updated provider information in internal databases, credentialing software (like CAQH or PECOS), and payer-specific systems.
• Acted as a liaison between providers, billing departments, and insurance payers to investigate and resolve enrollment issues, claim denials, or discrepancies.
• Staying current on the ever-changing federal, state, and payer-specific regulations and policies (e.g., CMS regulations, HIPAA) to ensure all enrollment activities adhere to compliance standards.
• Managed the revalidation process for previously enrolled providers and groups to prevent any lapses in coverage or billing ability.

Case Analyst II - Cognosante - Nashville, TN

(2017-12 - 2018-03)

• Resolved inquiries regarding healthcare program policies and eligibility for a variety of internal and external clients (e.g., beneficiaries, providers, and representatives of public and private organizations).
• Performed special investigations as requested.
• Created testing requirements.
• Tested data maintenance.
• Settled client case complaints by exchanging data and information across internal Cognosante departments and federal Marketplace staff.
• Administered and exchanged written, electronic, and/or verbal information/data to clients for services, premiums, and plan administration.
• Researched, Identified, and implemented consumer data issues related to health insurance exchange coverage.
• Provided detailed information regarding medication availability according to the client's Medicare Part D insurance tier.

Bachelor of Science - Business Administration - Columbia Southern University