BROOKE A. DOHERTY RN, BSN, MHA, CPC
Henryville
Summary
Strategic healthcare executive with 13+ years of leadership experience in payment integrity, healthcare economics, reimbursement strategy, affordability initiatives, and enterprise transformation. Proven success developing payment integrity concepts that improve claims accuracy, reduce avoidable medical spend, and deliver measurable financial impact across commercial, Medicare Advantage, and Medicaid programs.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Director, Healthcare Economics
Optum Insight
01.2024 - Current
- Led enterprise healthcare economics strategy, payment integrity innovation, affordability initiatives, and CRD portfolio management to enhance organizational performance.
- Led governance and prioritization of CRD portfolio, targeting $200M+ in annual savings through strategic initiatives.
- Partnered with Product, Payment Policy, Analytics, Compliance, Operations, and executive leadership to develop business cases and implementation strategies that align with organizational goals.
- Monitor reimbursement trends impacting commercial, Medicare, and Medicaid payment integrity strategies.
Associate Director
Optum Care Payment Integrity
01.2022 - 01.2024
- Oversaw payment integrity initiatives supporting Commercial, Medicare Advantage, and Medicaid populations.
- Led payment integrity initiatives for Commercial, Medicare Advantage, and Medicaid populations, enhancing compliance and reimbursement accuracy.
- Identified claims editing opportunities and collaborated on implementing payment policies, improving claims processing efficiency.
Clinical Audit Associate Director
Humana
01.2020 - 01.2022
- Oversaw six medical record review teams, leading 53 associates to ensure compliance and quality in reviews.
- Directed audit programs for Commercial, Medicare Advantage, and Medicaid business lines, enhancing regulatory adherence.
- Utilized CPT, HCPCS, ICD-10-CM, and revenue code expertise to validate reimbursements and support accurate financial outcomes.
Education
Master of Health Administration -
University of Phoenix
Bachelor of Science - Nursing
University of Louisville
Skills
- Payment integrity
- Payment Policy
- Payment Integrity Strategy
- Claims Editing
- Healthcare Analytics
- Cost Containment
- Medicare & Medicaid
- Financial Modeling
- Executive leadership
- Innovation leadership
- Investment Strategy
- Operational Efficiency
Accomplishments
- Provide strategic leadership for a $200M+ concept portfolio, driving enterprise payment integrity innovation, opportunity prioritization, and value realization.
- Accountable for delivery of approximately $20M in annualized payment integrity savings through reimbursement, audit, and claims accuracy initiatives.
- Led AI and NLP-enabled innovation initiatives improving payment integrity operations and opportunity development.
- Developed high-value concepts through partnerships with Product, Analytics, Payment Policy, Compliance, and Operations teams.
- Advanced initiatives from ideation through implementation and operational adoption.
Certification
- Registered Nurse (Compact Multi-State License)
- Certified Professional Coder (CPC)
Timeline
Director, Healthcare Economics
Optum Insight
01.2024 - Current
Associate Director
Optum Care Payment Integrity
01.2022 - 01.2024
Clinical Audit Associate Director
Humana
01.2020 - 01.2022
Bachelor of Science - Nursing
University of Louisville
Master of Health Administration -
University of Phoenix