Patient Representative Insurance Specialist
Resume:
Adina Kretchmar
Sierra Vista, Arizona 85635
Email Address adwqvz@r.postjobfree.com
I have been a Professional Patient Representative in the medical field with 22 years progressive experience in Medical Offices and for the last 3 years in a call center atmosphere as an insurance specialist for McKesson Specialty/Cover My Meds. The two companies merged in the summer of 2022.
Experience with NextGen, Cisco Spark messaging system, Microsoft Office including Excel and Word, Salesforce, Lightning Salesforce and Five-9.
Excellent communicator, trainer and team player.
EMPLOYMENT:
03/05/2022 to 03/29/2023 – SME / Insurance Specialist
I have been back as an insurance specialist now since 03/5/22 and having the knowledge of a Quality Assurance Analyst has made me a better insurance specialist. I now understand and appreciate the business practices and I strive to do great work all the time. I call payers, collect the needed information for the drug Ilumya (J3245) for both medical and pharmacy benefits and I make sure that I enter everything correctly in the cases that are assigned to me. After coming back to my role as an IS, I was asked by my supervisor to be a SME (Subject Matter Expert) for our group and was assigned 3 members of our IS team to help whenever help is needed. My role is to help them do great work and succeed in their note audits and daily work ethic. I am grateful for this role and that my supervisor trusts me enough with it.
11/15/2021 –03/04/2022– Blizzard Call Center QA Analyst
I was chosen to be a QA Analyst for the Genentech Program for Lucentis and Actemra. I worked the 5 Star evaluations for my agents. However, being an analyst during blizzard is limited in the requirements that a permanent QA analyst would normally get to do. I listened to and evaluated calls and made sure the documentation in the service requests or cases were correct. I got to then send out 5 Star Certificates to agents and their supervisors for excellent jobs well done. I did not get to meet with any of the agents to go over their calls or do any coaching of any kind. That was something that I was looking forward to doing but that is one of the major differences in the position of a blizzard QA Analyst. I really love helping and teaching people what the company expects from them and how to get to become and excellent agent and asset to the company. I have always been a helper and want to see people succeed and help them achieve their goals.
03/09/2020 – 11/14/2021– Insurance Specialist
My current responsibilities as an Insurance Specialist are to verify both major medical health plans and their pharmacy benefits for the medication Ilumya for Sun Pharma at McKesson. I make sure that I get all the necessary information on these plans to assist the providers that are prescribing the medication to their patients. I start a case, while working closely with the case manager and my teammates, by verifying the insurance, following up on prior authorizations and appeals and providing the needed help to anyone of my colleagues when they need assistance. Patient care is first and foremost and working closely with my teammates is essential in this position.
2014 – 2020 Patient Representative, Desert Ridge Family Physicians
Front desk responsibilities: check in patients, register new patients, collect co-pay at time of visit, verify insurance and manage patient accounts at time of check out.
Back-office responsibilities: appointment scheduling, prescription phone-ins, confirm Medicaid and supplemental allotments, calculate un and under-insurance discounts, work with billing to create payment plans and work with patient to collect balances NEXTGEN computer software.
Additional responsibilities: managed patient calls using Spark communication system, committee member for office birthday and holiday party planning, daily opening and closing of the office.
2012 - 2014 Front Office Representative, North Scottsdale Pediatrics
Responsibilities included all general medical front office duties.
2010 - 2012 Patient Representative, The Orthopedic Clinic Association
Responsible for front and back-office work in an extremely fast-paced orthopedic office.
Prepare daily cash deposit, post payments to client accounts, collect past due accounts, provide customer service to clients, reconcile customer accounts.
EDUCATION:
Westwood High school – General Diploma, June 1989
Several certifications in My Learning for QA, HIPPA, some leadership as well. I have several certificates for 100% in quality assurance and for going above and beyond to help out my team whenever it is needed.
PROFESSIONAL REFERENCES:
Mckesson Corporation / Cover My Meds
Ricky Powell
Direct Supervisor
Mckesson Corporation / Cover My Meds
Michael Guthrie
Sun Pharma Program Supervisor
Mckesson Corporation / Cover My Meds
McAaron Kraft
Sun Pharma Program / Supervisor
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