Data Entry & Healthcare Support Specialist

ERIN MARIE CRIST

Pittsburgh, PA

412-***-**** **********@*****.***

PROFESSIONAL SUMMARY

Experienced healthcare support and member services professional with extensive background in Medicaid and Medicare programs, prior authorizations, pharmacy support, patient advocacy, insurance coordination, and healthcare administration. Proven success supporting members, providers, and patients in high-volume healthcare environments while maintaining accuracy, professionalism, and compassionate service. Skilled in healthcare systems, benefits verification, EMR/EHR platforms, and resolving complex member and insurance issues.

CORE QUALIFICATIONS

• Medicaid & Medicare Member Services

• Prior Authorization Support

• Benefits Verification & Insurance Coordination

• Healthcare Customer Service

• Pharmacy & Specialty Medication Support

• Patient Advocacy & Care Coordination

• Medical Records & EMR/EHR Systems

• Claims Processing & Eligibility Verification

• Provider & Patient Communication

• Managed Care Operations

• Medical Terminology

• High-Volume Call Center Support

• Appeals & Case Documentation

• Scheduling & Intake Coordination

• HIPAA Compliance

• Multi-System & Multi-Screen Navigation

• Microsoft Office Suite

TECHNICAL SKILLS

Epic eCIS Aprima Express Scripts Systems CRM Systems MS Outlook MS Office MS Excel MS PowerPoint Data Entry Medical Coding & Billing PROFESSIONAL EXPERIENCE

Highmark Wholecare / Murtech Staffing

Member Services Representative – Medicaid Jan 2025 – Jul 2025

• Verified Medicaid eligibility and state benefits using Pennsylvania eCIS systems

• Assisted members with questions regarding medical billing, coverage, and benefit coordination

• Educated members regarding prior authorization requirements for imaging, outpatient services, therapies, and behavioral health services

• Coordinated transportation assistance, provider referrals, and appointment support for members

• Updated member records and ensured accurate documentation within internal systems

• Delivered compassionate and solution-focused customer service in a fast-paced managed care environment while navigating multiple healthcare systems and screens simultaneously

Highmark Wholecare Medicaid / Sigma, Inc.

Customer & Member Services Representative Apr 2022 – Dec 2022

• Conducted welcome calls for newly enrolled Medicaid members and reviewed available healthcare benefits and services

• Educated members regarding dental, vision, transportation, and ancillary benefits

• Assisted prospective members during special enrollment periods by explaining plan options and answering coverage questions

• Maintained high productivity standards while handling approximately 200–250 outbound calls daily and 100–150 inbound calls daily

• Directed members to appropriate healthcare programs, providers, and support resources based on individual needs

Paychex / Lancesoft

Operating Risk Management & Audit Specialist Nov 2021 – Jan 2022

• Audited overpayment and reimbursement requests for participant benefit programs

• Reviewed COBRA coverage timelines and approved eligible reimbursements

• Maintained accuracy and compliance while reviewing financial and benefits-related documentation

Cigna / Mindlance

Pharmacy Technician (Training Assignment) May 2021 – Jun 2021

• Updated patient medication records and verified active medical coverage

• Processed requests related to pulmonary hypertension therapies

• Confirmed prior authorization requirements and insurance eligibility information AmerisourceBergen

Benefits Verification Specialist / Customer Service Representative Jan 2020 – Mar 2020

• Verified insurance coverage and diagnosis information for specialty medication approvals

• Initiated prior authorization processes and coordinated with insurance carriers and physician offices

• Conducted outbound calls to obtain claims processing information and resolve coverage issues

• Escalated complex cases to appropriate internal departments when necessary Citizens Bank

Financial Education Specialist Aug 2019 – Oct 2019

• Assisted customers with Apple iPhone upgrade financing applications and account questions

• Explained financing qualifications, approval processes, and alternative payment options

• Delivered high-quality customer support while maintaining compliance with banking procedures

UPMC Health Plan

Customer Service Representative Apr 2019 – Jul 2019

• Assisted members with premium billing questions, payments, and online account support

• Supported Medicare members by answering plan questions and coordinating appointments

• Delivered personalized member support and resolved benefit-related inquiries efficiently

Home Care Delivered

Customer Service Representative Nov 2018 – Feb 2019

• Assisted patients with ordering medical supplies including diabetic, wound care, ostomy, catheter, and incontinence products

• Verified insurance coverage and processed test claims for medical supply orders

• Coordinated shipping information and order tracking support Morneau Shepell

Benefits Specialist Apr 2018 – Jul 2018

• Educated members regarding medical, disability, HSA, HFSA, and supplemental insurance benefits

• Assisted individuals in selecting benefit plans based on healthcare and financial needs

• Processed enrollment support and answered detailed benefits-related questions Highmark Health

Prior Authorization Specialist Oct 2017 – Jan 2018

• Reviewed prior authorization requests and supporting clinical documentation to determine medical necessity

• Verified prescription coverage and processed override requests

• Coordinated appeals processes and communicated case determinations to providers

• Ran test claims to confirm approval accuracy and benefit eligibility Gateway Health

Intake Coordinator Jun 2017 – Aug 2017

• Processed Medicare and Medicaid claims for Pennsylvania and Delaware members

• Coordinated medical prescription renewals and provider communications

• Scheduled physical therapy appointments and assisted with durable medical equipment orders

• Responded to provider inquiries regarding claims adjudication and authorization status

CVS Specialty Pharmacy / Express Scripts / Kelly Services Patient Care Advocate Nov 2015 – Mar 2016

• Assisted patients with specialty and mail-order pharmacy services

• Verified insurance coverage, processed medication orders, and addressed copay concerns

• Supported patients applying for copay assistance and financial grant programs

• Collaborated with pharmacists, providers, and insurance carriers to resolve prescription issues

Private Caregiver – Romero Family

Caregiver Nov 2012 – Nov 2015

• Provided compassionate in-home care for patients with CHF and activities of daily living needs

• Assisted with medication administration, ambulation, nutrition, hygiene, and medical monitoring

• Supported patient safety, comfort, and quality of life in a home healthcare environment

UPMC Magee-Womens Hospital / Allegheny General Hospital Cancer Center Medical Assistant Mar 2011 – Aug 2012

• Performed front and back office medical assistant duties in specialty healthcare settings

• Conducted patient assessments, EKGs, scheduling, chart preparation, and insurance authorizations

• Assisted physicians with examinations, minor procedures, laboratory tasks, and diagnostic testing

• Maintained accurate patient documentation within electronic health record systems

Merrill Lynch / Home Loan Services

Loss Mitigation Specialist Mar 2007 – Oct 2009

• Assisted customers with mortgage repayment plans, loan modification options, and foreclosure alternatives

• Evaluated financial hardship situations and explained available assistance programs

• Maintained sensitive customer communications while resolving complex financial concerns

PNC Bank

Customer Service Representative Apr 2006 – Dec 2006

• Assisted customers with banking products, loan inquiries, and account support

• Handled inbound and outbound customer service communications

• Supported customers with resolving account discrepancies and service questions EDUCATION

Bidwell Training Center, Inc.

Electronic Record Medical Assistant Diploma 2010

• Completed externship at UPMC Presbyterian Montefiore General Internal Medicine Orange Coast College

General Studies Coursework – Life Sciences Concentration ADDITIONAL INFORMATION

Career pause for medical treatment and recovery from 2023–2024. Successfully returned to the workforce in healthcare member services and administrative support roles. Currently preparing to pursue Medical Assistant recertification to further expand clinical and healthcare support opportunities.

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