Customer Service Representative

Evelyn R. Grayer

Cell 601-***-****

*************@*****.***

Career Objective

I am seeking an administrative or customer service role where I can leverage my experience and proactive approach to provide exceptional support. As a Pharmacy Coordinator at Mississippi Discount Drugs LTC, I managed inventory and resolved billing discrepancies, drawing on extensive knowledge of Medicare and Medicaid Part D, as well as proficiency with Epic EHR claims.

Skills

Well-Organized Excellent Communication 65 WPM Inpatient/Outpatient Pharmacy Tech. Claims Billing Epic EHR AS400 CRM Prime Care LTC

Experience

J.P. Morgan Chase Customer Service Rep. 11/2007 to 11/2024

Handle heavy call volume daily.

Provided personalized service to customer accounts in the post-fund department.

Responded and submitted requests for deferments, forbearances, and repayment plans.

Executed transactions promptly and accurately and resolved all issues within a 48-hour turnaround time based on the company’s policy.

Processed private loan applications and verified all account information.

Educated and coached customers with student loan guidelines.

Gulf South Medical Supply Pharmacy Coordinator 03/2022 to 10/2024

Orders, receives, and maintains inventory of drugs and chemicals, ensuring their security, accuracy, and timely rectification of any billing errors, which are recorded monthly.

Entered data into the CRM, recorded prescriptions, purchased orders, and stocked orders.

Removed expired, outdated drugs from stock and properly disposed of them.

Inspects and restocks all used facility ER kits and updates expiration dates on the computer.

Performs computer order entries.

Cleaned equipment and glassware according to recommended methods.

Assisted in preparing medication deliveries to facilities (in compliance with HIPAA regulations).

WellCare Health Plan Prior Authorization Rep. 09/2017 to 10/2023

Accurately completed reviews for medication for Medicare Part D for Prior Authorizations, Formulary Exceptions, and Drug utilization and PBM.

Completed reviews for medications for Part D, according to plans and Routes for CMS Guidelines, Aids physicians, office staff, and patients.

Completed and submitted all necessary UB92 & CMS1500 claims Forms, explained EOBS and eligibility dates.

Provided exceptional customer service to internal and external customers.

Resolved Beneficiary requests in a timely and accurate manner.

Centene Health Plan Provider Service Representative II 06/2007 to 10/2015

- Maintained consistent communication with providers, office managers, nursing staff, third-party customer service representatives, pharmacy personnel, and case managers through phone, fax, and email.

Assisted physician office staff and patients by facilitating the completion and submission of insurance and claims documentation.

- Provided high-quality customer service to both internal and external stakeholders while meeting established deadlines.

Verified benefits, eligibility per the call matrix, HIPAA/PHI regulations, escalation protocols, and grievance procedures, ensuring clear communication with both staff and beneficiaries.

Education

Townsend Pharmacy Institute Pharmacy Certification

Provine High School High School Diploma

BLS Certification

References Available Upon Request

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