Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

Kelly Weaver

Tolono

Summary

My goal is to find a position with a company where I can utilize my knowledge of healthcare practices, benefit verification and claim pricing. I am a very hands-on learner. My current job is a new position for the organization within the last couple years, and I have created a system that has allowed me to complete my tasks in a timely and accurate fashion. I am always willing to take on new tasks and eager to learn new projects.

Overview

29
29
years of professional experience
1
1
Certification

Work History

Pharmacy Claims Pricing and Audit Coordinator

Health Alliance
04.2018 - Current
  • Claims Pricing for high-cost medical drugs and home infusion
  • Quarterly Audit Reports
  • Create single-case agreements for non-contracted providers
  • Submit tickets to PBM/Optum to correct DED/OOP
  • Work reports that have helped find additional cost savings
  • Reprocess claims found in reports to receive refunds
  • Epic/Tapestry System for claims pricing
  • Work with the Operations Coordinators to create authorizations
  • Work with Medicare and Commercial plan benefits
  • Customer Service Phone Calls
  • On-Call rotation

Insurance Verification Specialist

Coram Home Infusion
09.2011 - 04.2018
  • Benefit Verification
  • Date entry for new members
  • Obtain authorizations for members
  • Schedule delivery and nursing for home infusion patients
  • Inventory
  • Customer service phone calls

Supervisor Heart and Vascular Institute

Carle Health
07.1996 - 09.2011
  • Supervise frontline staff
  • On-call and office schedules for Cardiology providers
  • Timekeeping
  • Staff meetings
  • Staff schedules
  • Annual reviews
  • Room patients and take vitals

Education

Associate Of Business Administration - Business Administration

University Of Phoenix
Phoenix, AZ
05.2010

Skills

  • Management courses
  • Problem Solving
  • Communication
  • Leadership
  • Punctuality
  • Fast learner
  • Attention to detail
  • Epic Tapestry
  • Microsoft Office
  • RXClaim system
  • RJ Health system
  • Evicore system

Certification

Certified/Licensed Pharmacy Technician, 2013

Languages

English
Native or Bilingual

Timeline

Pharmacy Claims Pricing and Audit Coordinator

Health Alliance
04.2018 - Current

Insurance Verification Specialist

Coram Home Infusion
09.2011 - 04.2018

Supervisor Heart and Vascular Institute

Carle Health
07.1996 - 09.2011

Associate Of Business Administration - Business Administration

University Of Phoenix

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Kelly Weaver