Welcome to Brazen Careerist!

Work History

• Wellcare
• Pharmacy Technician
• December 2010 to Present

• • Currently working Medicaid, Medicare and PDP LOB.
  • Receives and responds to calls from physicians and pharmacists
  • Enters Drug Evaluation Review (DER) overrides into the WHI system on a timely basis.
  • Responds to requests from member service and other issues.
  • Reviews member profiles for the 4 brand limit and sends letters to physicians with recommendations for changing therapies, and prepares denial letters for approval by Pharmacists.
  • Follows DER guidelines to make decisions on approvals and/or denials on various drug products that are not in our formulary plans.
  • Performs special projects as assigned.

• United Health Care
• Customer Service Representative
• August 2010 to December 2010

• • Respond to complex provider calls
  • Resolve provider service inquiries which could include:
  o Benefit and Eligibility information
  o Billing and Payment issues
  o Customer material requests
  o Physician assignments
  o Authorization for treatment
  • Explanation of Benefits (EOB) / Provider Remittance Advice (PRA)
  • Twenty quality surveys at 98% Accuracy
  • 6 Provider reviews at 99% average
  • Average call time 5 minutes
  • Constantly meet established productivity, schedule adherence, and quality standards

• CCS Medical
• Pharmacy Patient Care Representative
• August 2009 to August 2010

• • Filling Prescriptions Orders
  • Setting Up and updating shipments
  • Verification of Insurance
  • Obtaining information for Prior Authorization on medications
  • Interaction with Doctor Offices and insurance companies in obtaining and providing medication information.
  • Awarded for exceeding processing goal
  • Proper Usage of DAW codes
  • Exceed productivity goals by double for 8 months in a row
  • Awarded for reduced shipping errors below standard guidelines

• CCS Medical
• Inbound Billing
• June 2008 to August 2009

• • Informing patients of their balances
  • Working with insurance representatives and customers
  • Explanations of DME deductibles
  • Expiations of EOB’s and Timely filing
  • Awarded for Top collector in August
  • Excelled in call numbers and daily tasks
  • In charge of department spread sheets for balance adjustments
  • In charge of department spread sheets for account deletions
  • Created department training manual
  • Created time management spread sheets
  • Created and In charge of quarterly recycling event
  • In charge of Voice Mails for the department
  • Helped in training new hires and current employees
  • Helped in verifying completion other coworkers work
  • Temporary Head Admin for Corporate Reimbursement Office
  • Create and maintain expense reports for the VP of Reimbursement

• Anesthesiology Associates
• Data Entry
• Febuary 2007 to April 2008

• • Organization of medical schedules by date and company, along with patients cards by accounts and company to enter into Medical Manager for billing use.
  • Data Entry of patient information, billable procedures and diagnostic codes.
  • Weekly interaction with Oak Hill and Community Hospital regarding new doctors, inserting their UPINs and NPIs into Medical Manager.
  • Compiling and processing the insurance information using Health Information Claim Forms.
  • Direct involvement with patients regarding account balances. Making all patients information streamlined so that our productivity as an office went up by about twenty percent

Education

• ST. Petersburg College
• AS. Mass Communications
• 2007 - 2010

• ST. Petersburg College
• BS Management and Organizational Leadership, Sustainability, Project Management
• 2011 -