Customer Service Entry
Resume:
DANIELLE KLUESNER (DANI) *** N.E. *th Street Ankeny, Iowa 50021 515-
QUALIFICATIONS PROFILE
Highly efficient professional with over 10 years of experience in areas of Iowa Medicaid project, retail
pharmacy, third party billing, and customer service.
1Background in practical settings involving heavy telephone contact and interaction with healthcare
providers for prior authorization requests.
2Expertise in communicating healthcare insurance issues effectively to diverse individuals.
3Extremely focused skilled in following detailed practices and procedures.
4Inspire confidence and gain trust through attentive service and efficient problem solving.
5Excellent decision-making, critical thinking, and analytical abilities.
PROFESSIONAL EXPERIENCE
MERWIN LONGTERM CARE – Ankeny, Iowa 2008 to 2010
Order Entry, 2008 to 2009
1 Enter new orders into correct facility and correct patient, refill orders as requested by facility into
QS1 PrimeCare system.
2 Print Medical & Treatment Records for facilities.
3 Call facilities with any order questions and answer any incoming calls for order entry.
4 Credit returned medications.
5 Restock & Bill E-Kits.
Fill Technician
1 Fill prescriptions with correct medication, double checking strength &
manufacturer.
2 Check in & put away medication order.
Driver
1 Print delivery sheets.
2 Deliver medication orders to the facilities.
KPS/PHARMERICA – Urbandale, Iowa 2007 to 2008
Order Entry, 2007 to 2008
1 Sort and file incoming faxes into facility slot.
2 Enter new orders into correct facility and correct patient, refill orders as requested by
facility into QS1 system.
3 Print Medical & Treatment Records for facilities.
4 Call facilities with any order questions and answer any incoming calls for order entry.
5 Train new order entry techs.
ING ANNUITY AND LIFE INSURANCE COMPANY – Des Moines, IA 2006 to 2007
Customer Service Associate, 2006 to 2007
1 Answer incoming calls regarding annuity products.
2 Submit service requests to correct policy errors or request additional information for the
client.
3 Assist co-workers and clients by proactively applying the First Call Resolution principle.
4 Make outbound calls to clients regarding prior issues.
5 Support co-workers by acting as an information resource.
KINDRED PHARMACY SERVICES – Hatfield, Pennsylvania 2005 to 2006
Order Entry, 2005 to 2006
1 Sort and file incoming faxes into facility and time slot.
2 Enter new orders into correct facility and correct patient, refill orders as requested by
facility into QS1 system.
3 Correct any mistakes found by the checking pharmacists and any errors found by Medical
Records.
4 Call facilities with any order questions and answer any incoming calls for order entry.
5 Train new order entry techs.
ACS STATE HEALTHCARE – West Des Moines, Iowa 2000 to 2005
Field Rep, 2005
1Maintain Isis File by reconciling Isis to ACS mainframe
2Resolve outstanding inquiries regarding Isis File
3Coordinate printing and mailing of Informational updates to Providers
4Review Waiver claims and Concurrent Care claims to verify whether criteria has been met so that
claim may be paid.
Customer Care Specialist Unit Lead, 2004 to 2005
Coordinate the daily running of the drug prior authorization unit to maximize efficiency.
1Sorted and Forwarded work to Atlanta according for authorization, according to priority.
2Maximized staff talents by disbursing work according to their strengths.
3Added to staff effectiveness by training staff with new departmental skills, thereby giving the staff
the skills to help out wherever there is a need.
4Coordinated a successful inter-departmental effort to catch the drug pa backlog up.
Customer Care Specialist, 2000 to 2004
Approve or deny drug prior authorization requests from pharmacies and other healthcare
providers via incoming calls. Research patient medication histories.
1Contact providers with decisions on drug prior authorization requests; effectively convey reason(s)
for approval or denial.
2Answer questions and clearly explain processing of claims and drug prior authorization criteria.
3Research and process requests for ProDUR edit overrides.
4Maximize staff’s effectiveness by training new Customer Care Specialists.
EDUCATIONAL BACKGROUND
IOWA STATE UNIVERSITY, Ames, Iowa
Bachelor of Science Degree in History; 1997
ANKENY SENIOR HIGH SCHOOL, Ankeny, Iowa
Diploma; 1992
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