Bria Mcgough

Professional Summary Operations professional with 10+ years of experience leading teams, streamlining healthcare support workflows, and delivering measurable performance results. Skilled in SOP development, agent management, quality assurance, and regulatory compliance. Excels at optimizing healthcare operations through staff coaching, SLA adherence, and process innovation. Currently advancing business and project leadership skills through PMP coursework and a Bachelor of Science in Business. Core Competencies Virtual Operations & Remote Workforce Management Healthcare Claims & Benefits Navigation (SPARCS, CoverMyMeds) SOP Development & Quality Assurance SLA Compliance & Performance Metrics HIPAA/PHI Compliance & Confidential Data Handling Payroll Processing & Scheduling Client Experience Optimization & Escalation Resolution Microsoft Office Suite | CRM Tools | Remote Collaboration Platforms Professional Experience Owner & Operations Director Independent Business Partner – Arise Virtual Solutions | Remote | 2016–Present Founded and managed a certified Arise-affiliated virtual call center supporting healthcare, travel, and retail clients. Hired, onboarded, and supervised independent contractors, establishing clear expectations around KPIs and SLA deliverables. Reviewed company-wide SLAs and conducted one-on-one SLA briefings with every new agent to ensure alignment and accountability. Designed and implemented SOPs, training guides, and performance tracking systems to standardize operations and improve service delivery. Coached agents using quality monitoring tools and client-specific dashboards, resulting in improved customer satisfaction scores. Processed biweekly payroll for contractors using digital timekeeping and compensation platforms. Maintained 100% compliance with Arise platform requirements and client confidentiality policies, including HIPAA. Benefits Verification Specialist (Part Time Contract) Omni Interactions – CVS Specialty Program | Remote |- Conduct benefit verifications and manage referral workflows for specialty pharmacy requests across Medicare, Medicaid, and private insurance plans. Utilize SPARCS, CoverMyMeds, and other systems to document, escalate, and resolve benefit denials or delays. Improve authorization timelines and patient outcomes through proactive provider communication and issue resolution. Client Services Jr. Operations Coordinator Foundation Medicine | Morrisville, NC |- Oversaw the end-to-end coordination of genomic test orders, managing cross-functional workflows between providers, insurance carriers, and internal teams to ensure timely case resolution. Streamlined operations for insurance verification and documentation review by implementing tracking systems and identifying process bottlenecks. Acted as primary operations liaison for escalated cases, using data-driven insights to troubleshoot delays and maintain service level expectations. Monitored fulfillment KPIs and worked collaboratively with labs and billing teams to reduce turnaround times and enhance the patient experience. Contributed to continuous improvement initiatives by documenting process gaps and assisting in the development of updated workflow procedures. Claims Processor Beacon Health Options | Morrisville, NC |- Processed a high volume of behavioral health claims with precision, verifying patient eligibility, provider credentials, and correct ICD/CPT coding prior to adjudication. Utilized internal claims platforms to audit submissions, flag discrepancies, and ensure compliance with Medicaid, Medicare, and private payer guidelines. Communicated directly with providers and internal departments to resolve claim issues, contributing to a 15–20% reduction in rework and delayed payments. Tracked claim turnaround times and documented productivity benchmarks to support operational reporting and quality assurance targets. Played a key role in onboarding and mentoring junior claims processors by delivering hands-on training in system navigation, documentation standards, and payer policy updates. Supported workflow optimization efforts by identifying recurring errors and proposing solutions to streamline front-end claims intake. Additional Roles Pharmacy Helpline Representative – Xerox Inc Telecommunications Officer – Franklin County & City of Durham 911 Cardiovascular Tech Intern – Duke Regional Hospital Education & Certifications Bachelor of Science in Business – In Progress Project Management Professional (PMP) Certification Course – Currently Enrolled Certified EKG Technician – Expires Nov 2023 CPR/BLS Certified – Expires Oct 2026 IAED Emergency Dispatch Certification High School Diploma – J.F. Webb School of Health & Life Sciences