Kelly Weaver
Tolono
Summary
Certified Pharmacy Technician (CPhT) with a strong background in pharmacy claims processing, customer service, and benefit verification. I am passionate about delivering quality patient care and ensuring efficient operations in the healthcare industry.
Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Claims Pricing
Health Alliance Medical Plans
04.2018 - Current
- Claims Pricing for high-cost medical, chemotherapy drugs drugs and home infusion
- Complete quarterly audit reports for specialty medications, and accumulation issues.
- Create single-case agreements for non-contracted providers.
- Submit tickets to PBM/Optum to correct DED/OOP discrepancies
- Work reports that have helped find additional cost savings
- Reprocess claims found in reports to receive refunds.
- Epic/Tapestry System for claims pricing.
- Create medication prior authorizations
- Create approval/denial correspondence.
- Verify Medicare and Commercial benefits
- Attend Medicare Benefit Meetings for members
- On-Call rotation
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Recognized by management for providing exceptional customer service.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Assisted with customer requests and answered questions to improve satisfaction.
- Utilized various software and tools to streamline processes and optimize performance.
- Completed day-to-day duties accurately and efficiently.
- Maintained updated knowledge through continuing education and advanced training.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Worked with cross-functional teams to achieve goals.
Insurance Verification Specialist
Coram Home Infusion Pharmacy
Champaign
09.2011 - 04.2018
- Provided customer service support to address questions or concerns from members.
- Verified that patients had proper insurance coverage prior to medication delivery.
- Conducted follow-ups with insurance companies to expedite verification processes.
- Handled billing related activities focused on medical specialties.
- Maintained up-to-date knowledge of insurance policies, including Medicare and Medicaid.
- Liaised with insurance companies to obtain pre-authorizations for medications.
- Utilized electronic medical records (EMR) systems for documenting verification processes.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Maintained confidentiality of patient information in accordance with HIPAA regulations.
- Educated patients on their insurance benefits and coverage limitations.
Supervisor
Carle Health Heart and Vascular Institute
Urbana
07.1996 - 09.2011
- Created on-call and office schedules for Cardiology providers.
- Evaluated needs of departments and delegated tasks to optimize overall production.
- Monitored employee attendance, addressing any punctuality or absenteeism issues.
- Worked closely with human resources to support employee management and organizational planning.
- Led weekly team meetings to discuss progress, address issues, and plan future actions.
- Trained new employees on company policies, job duties, and performance expectations.
- Managed scheduling for staff, ensuring adequate coverage during peak times and projects.
- Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.
- Conducted regular performance evaluations, providing constructive feedback and setting individual goals.
Education
Associate's degree - Business Administration
University Of Phoenix
Skills
- Problem solving
- Communication
- Leadership
- Punctuality
- Epic Tapestry
- Microsoft Office
- RXClaim system
- RJ Health system
- Evicore system
- Claims pricing
Certification
Certified/Licensed Pharmacy Technician, 2013
Timeline
Claims Pricing
Health Alliance Medical Plans
04.2018 - Current
Insurance Verification Specialist
Coram Home Infusion Pharmacy
09.2011 - 04.2018
Supervisor
Carle Health Heart and Vascular Institute
07.1996 - 09.2011
Associate's degree - Business Administration
University Of Phoenix