Communication and Data Specialist

• Updated, validated and finalized provider contracts in insurance contract database.
• Utilized excel as a resource to verify and validate contracts.
• Researched and verified all anomaly provider data and patient data for claim processing.
• Utilize company resources to complete all tasks and projects accurately and timely.
• Analyze and update data from Excel to ensure that all provider contracts meet the criteria of the State approved Medicaid plans.
• Interactions and communications daily between departments to verify and clarify all newly updated contract data.

• Accessed insurance providers portals to verify the eligibility of the patient and to complete the authorization process.
• Proactively submit authorizations prior to expiration dates.
• Obtained up-to- date clinical and non- clinical documents required for services.
• Maintain COH (claims on hold) report at 5% percent allowing minimization of bad debt for the company.
• Communicate effectively with all departments to ensure services are valid and authorized to prevent breaks or discontinuation of therapy.
• Prioritized and addressed all claims from the Claims on Hold report (COH) tasks daily.

• Monitored and documented clinical results daily based up patient’s therapy completion.
• Updated clinical and non-clinical information in Hepatitis C primary database.
• Created Hepatitis C project SOP for Cigna minimizing errors in reporting and documentation.
• Worked independently and was available to assist with all inquiries related to the Hepatitis C project.
• Successfully trained internal and external workers on Hepatitis C objectives counteracting conflicting data and creating autonomous tracking
• Interacted with internal and external partners via fax, phone, and mail daily.
• Obtained verbal and written accolades for successfully meeting goals and accumulating data that management requested.

• Interacted with customers, providers, and pharmacies to streamline medication authorization process.
• Collaborated with other departments to minimize therapy interruptions for patients.
• Assisted training classes as a SME.
• Prioritized and completed daily tasks in a timely manner.
• Implemented de-escalation techniques for escalated calls as needed.
• Type 45 wpm

• Navigated multiple systems daily with minimal downtime.
• Cross trained in all pharmacy authorization functions within 12 months of employment.
• Minimal supervision required for 'special projects’ and standard job tasks.
• Maintained and exceeded metrics across all lines of business that I was trained.
• Customer service successful as noted by the patients and management via awards.
• Mentored New Hire classes and Specialty drug training classes as needed.
• Validate and advised patients about their eligibility and benefits per HIPAA guidelines.
• Type 40 wpm

High School Diploma

Bachelor of Science

Master of Science

Medical Management