Pharmacy Caseworker and Credentialing Team Lead

Chandra Franklin

Phoenix, AZ ***** +1-602-***-**** *******************@*****.***

Willing to relocate to: Tempe, AZ

Work Experience

Pharmacy Caseworker

Assist Rx Phoenix, AZ

December 2025 to March 2026

The Caseworker supports and Act as a liaison for field representatives, health care providers and patients addressing questions with healthcare providers & insurance plans/payers to gather information about a patient’s insurance coverage for a specific pharmaceutical product. Conducting inbound about prescriptions, dosages, prices, refills, diagnosis codes, Pre-adverse affects. This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the process to access medications, to initiate the prior authorizations for patients by making outbound phone call to payers to verify patient insurance benefit information, navigate complex reimbursement barriers and seek resources to overcome the barriers, conducted benefit investigations for patients by making outbound phone call to payers to verify patient insurance benefit information, Verified patient specific benefits and document specifics including coverage, cost share and access/provider options, Identified any coverage restrictions and details on how to expedite patient access to medications. Provided accurate, timely, and professional customer service support to patients, providers, and partners. Responded to inbound inquiries related to healthcare programs and pharmacy benefit investigations. Guided callers through program requirements and next steps. De-escalate and resolve customer concerns with empathy and professionalism, Collaborate with other call center representatives to improve service quality and consistency. Maintain compliance with HIPAA and internal data protection standards. Documented interactions accurately within designated systems. Performed other related duties as assigned Credentialing Team Lead

Compunnel Staffing/AETNA-CVS Health Phoenix, AZ

January 2025 to April 2025

Worked remotely Assisting with Credentialing and Auditing various Practitioners. The credentialing coordinator is responsible for all aspects of credentialing and pre credentialing of health care professionals this position ensures all health care professionals are appropriately credentialed and up to date, timely completion of heath care professionals credentialing application and insurance records to maintain licensing. Elite plans to allow providers to participate in network (provider enrollment) connecting health care entities that have a need to hire or otherwise engage providers. developed internal credentialing process to data entry of new applicants in the credentialing database, using credentialing apps such as SAM, AGO & CAQH which has worked with plans, practices, groups and other organizations to make collecting, verifying and exchanging information needed for credentialing efficient and secure for monitoring Practitioners for lawsuits, Sanctions, expired licenses, credential expirations dates, updating renewal by dates, update certifications, review sanctions, prepare and scan credentialing statues and credentialing documentation into scanning software to Ensure up to date records, licenses, certifications documented to support the facility and staff members and maintain compliance with regulatory and accrediting institutions, Invoicing Collector

Trajector Medical Mesa, AZ

June 2022 to November 2023

Worked remotely handling high-volume inbound calls, from Veterans wanting to discuss contracts, Invoices, and payments due. Authorized and set up payment plans, explained supplemental fees, monthly charges, monthly interest, explaining to clients in detail about medical evaluation results, so they could understand Trajectory’s Medical evaluation fees. which produced the invoices for which they are responsible. I performed administrative clerical functions, recording address changes, updating customer demographic information, answering questions. Handled complaints from customer regarding bills with efficiency and accuracy. Collected documentation, reviewed documents, researched accuracy of invoices using Veterans account info, compiled evident history of claims, to verify the accuracy Ability using policy and procedure to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to define problems, collected data, establishes facts, and draw valid conclusions; ability to interpret an extensive variety of instructions both oral and written verify invoice accuracy. Issue customer account statements monthly or as required. Send updates about resolved Invoice Disputes through various channels (postal mail, email, text messages, etc.) Receive payments through various methods (check, online payments, etc.) handling collections of payments, Reply and documentation from Correspondences and disputed invoices and Send reminders for payments and contact customers when assigned Update accounting records with new payments, Collects and posts payments to customer accounts. Document any pertinent data on collection efforts and customer financial status in database. Collection/Loss Mitigation Specialist

LoanCare

November 2019 to September 2020

Worked in a high volume inbound call center handling inbound loan servicing collections calls, must be able to ask fact finding questions and provide accurate loan updates statuses, reason for delinquency, discussed barriers, Persuaded delinquent homeowners to become current, negotiated repayment terms and scheduled payments, updated financial status, developed alternative payment plan minimized objections, advised on all loss mitigation options including forbearance, reinstatement, repayment plans, partial claims, deferments, foreclosures and loan modifications. Updated customer information as required by polices and regulations receive inbound calls from customers and document accounts, followed and adhere to all company policies and procedures, Mortgage collectors follow the Fair Debt Collections Practices Act (FDCPA) and company policies when negotiating with customers. This includes working in accordance with privacy laws and legal requirements regarding mortgage contracts. Mortgage collectors are responsible for contacting customers regarding the status of their account. They notify them of any fees that are due and inform debtors of their situation with the company. After discussing finances with customers, mortgage collectors evaluate their financial ability to pay back their debt. They offer alternative payment plans or methods to help customers with their situation. Mortgage collectors document all incoming and outgoing collection efforts to maintain compliance with established standards. This includes keeping information such as phone numbers and mailing addresses up to date, and making sure that all correspondence is properly recorded for future case reviews. .Displaying excellent problem-solving, time- management, organizational, and math skills

Collections Associate

Alpha Recovery Corp Mesa, AZ

December 2018 to November 2019

Worked in a high volume, fast-paced inbound and outbound call center environment Handled anywhere between 150 - 250 calls daily

Assisted Borrowers over the phone via 3rd party, to resolve and negotiate repayments Collected on charged off credit and debit cards for Bank of America, Dell Financial Services, Citibank, Capital One, Discover, and Chase Bank

Utilized multi system switchboard tool Accurint to perform due diligences and skip tracing Followed State and FDCPA Guidelines to supervised and train staff Provided updated procedures and material such as Quality Assurance (QA) manuals for section trainers Gathered information and prepared statistical / narrative reports using Microsoft Excel and Access Front End Collections Rep

Ditech Financial LLC

June 2018 to November 2018

Worked in a high-volume inbound call center handling around 100 calls daily, handled loan servicing collections calls, persuaded delinquent homeowners to become current while using professionalism, tact and adhering to all applicable collections' laws. Educated homeowners of Loan repayment terms, all loan modification programs, forbearance plans, repayment plans, short sales, and deed in lieu options as applicable. Calculated income, expenses and reviewed escrow advances, balances, shortages/overages. Submitted Loss Mitigation Surveys, packages and recorded incoming documents. Submitted Insurance claims, Deferment and Forbearance Request, complaints, Contract changes and updates, payoff request, payment history, Escrow Analysis, Billing Statements. Answered inbound/outbound calls, returned voicemails, emails and handled escalations, and all other request within 24 hours from receipt. Senior Customer Service Advisor (Property Management) Renters Warehouse

April 2017 to March 2018

Worked in a high volume, fast-paced inbound and outbound call center environment doing Property Management for Nationwide Property Management firm. Responded to incoming calls both verbal and written, identified and assessed customers’ needs quickly and accurately, solved problems systematically using sound business judgment. Applied appropriate communication techniques when responding to escalated and particularly stressful situations, followed up on service issues to ensure timely and accurate resolution, placed outgoing calls to complete follow-up on customer requests. Acted as Liaison between Tenant, and Property Owner Collected rent on a monthly bases, and handled late payment in timely fashion Basic accounting, explained Tenant/Owner statements, Fees (mgt, admin, etc.) made necessary deductions, adjustment, credits, Explained Lease options, buyouts, tenant exchange and lease modification procedures, coordinated maintenance schedules with, Contractors, HOA’s maintained timely and accurate documentation of all communications.

EBO Representative

Emerald AR

May 2016 to April 2017

Worked in a high volume, fast-paced inbound and outbound call center environment. Handled incoming calls from patients and insurance companies regarding clams and patients balances. Made outbound phone calls and take inbound calls from patients to offer payment options and solutions to help them resolve their medical expenses while keeping our clients payment specifics and mission and vision statements in mind. Note each phone call and conversation in our client's system. Additional documentation may be need based on the client. Take payments using our client’s payment portals while complying with federal guidelines. Used mail and email to contact client to negotiate payment to resolve outstanding medical bill accounts and balances, obtained agreement on potential payoff and/ or negotiate payments that resolved outstanding medical bills accounts and balances. Comply with state and federal laws that govern our agency along with guidelines that govern our clients as well (HIPAA). Processed patient data such as treatment records and related insurance information, knowledge of patient medical record and medical terminology, diagnostic codes, procedures performed, so the facility Can bill insurance and other third- party payers (such as Medicare or Medical) as well as patients. Worked along and in conjunction with clinics, physicians and a variety of healthcare facilities. Added Insurance and Submitted Insurance Applications. Account Receivables, Billing, for Radiologist, Clinics and Hospitals in the Los Angeles Area. Posted Patients payments by recording cash, checks, and credit card transactions. Resolved all Billing disputes; made inquiries, researches and communicates with internal and external customers. Run daily ageing report to identify any outstanding accounts and commence follow-up and procedure. Debt Collector

Gatestone & Co.

September 2015 to April 2016

Worked in a high volume, fast-paced inbound and outbound call center environment. Handled anywhere between 200 - 300 calls daily using an Auto Dialer with little to no breaks between calls. Assisted consumers via phone to evaluate their financial situation with the intent of obtaining repayments. Negotiated (settlements or payment in full) for restitution judgments, mortgage debts, student loans, and other sources of capital borrowed from financial institutions. Monitored daily production to ensure work was completed daily to adhere to service level. Responsible for all ACH requests, wires transfers, debits, cash payments/ deposits and made sure all transactions equal bank. Trained yearly on Anti Money Laundering, Bank Secrecy Act, and Office of Foreign Asset Control, and followed State FDCPA Guidelines. Developed and utilized strong, highly effective collections techniques. Resolved all Collections disputes; made inquiries, researches and communicates with internal and external customers. Provided superior customer service to financial advisors to help them grow their business. Used all 3 risk management policies to control fraud. Collected for clients including: Maricopa County Adult Probation Department; Arizona StateDepartment City of Phoenix; Greentree Servicing. Debt Collector

Primary Financial Services

November 2013 to December 2014

Worked in a high volume, fast-paced inbound and outbound call center environment. Handled anywhere between 250 - 300 calls daily using an Auto Dialer with little to no breaks between calls, assisted consumers via phone to evaluate their financial situation with the intent of obtaining repayments. Negotiated (settlements or payment in full) for automobile loans, charged off credit card debts, student loans, and other sources of capital borrowed from financial institutions. Collected for clients including: Wells Fargo credit cards / home mortgages; Technology Solutions Federal Credit Union; Toyota auto finances; and Sallie Mae student loans. Education

Advanced Science of Behavior Health (Associates Degree) South Mountain Community College

Science of Behavior Health (Associate's degree)

South Mountain Community College Phoenix, AZ

High school diploma or GED

Skills

Client email correspondence General Ledger Accounting Financial sales Front desk iOS Active listening Continuous improvement Project coordination Account analysis Social media management Clerical experience Healthcare compliance B2B VoIP Healthcare support Computer skills Microsoft Access Auto loan debt collection accounts Financial compliance Medical claims processing Education administration Zoom Google Drive Centers for Medicare and Medicaid Services (CMS) PCI Technical Proficiency CRM software Medical records Medical claim denial management Payroll Analysis skills Multi-line phone systems Assembly Lexis-Nexis Administrative experience Fraud NetSuite Canva Databases Account reconciliation Phone call management Record keeping Insurance prior authorization Contracts Accounts Receivable Google Suite Debt collection legal action Empathy Customer support Conflict management Maintenance activity documentation Order entry Experian (debt collection software) Appointment scheduling Technical troubleshooting support Anti-money laundering Outbound calling Appeals SharePoint Call center experience Phone reception Workday Budgeting Typing Oracle Research Latitude (debt collection software) Relationship management Addiction counseling Financial regulatory compliance Google Docs Improving customer support response time Journal entries Leadership HIPAA Medical software Salesforce Settlement negotiation Customer relationship management Senior leadership Insurance verification Computer operation Medical claims Basic math Mobile devices Individual consumer customer service Negotiation Office Management Accounting and finance experience Glazing Pharmacy technician experience Medical billing Pest control Microsoft Excel Accounts payable Student loan debt collection accounts Financial concepts Mortgage debt collection accounts Health insurance sales Financial management Call center Data entry ACH Jira Outbound sales Closing sales Collect!

(software) Microsoft Outlook Property management tools Processing cash transactions Customer issue escalation Credit analysis Debt collection skip tracing Grammar Experience Back-end development Microsoft Project Consultative selling Microsoft Office Helpfulness Experience working with students Task prioritization GAAP IT Loan loss mitigation Cross- selling Teamwork Upselling Process optimization Financial aid Retail sales CRM system proficiency Achieving HIPAA compliance Client services Records management Manufacturing Key Performance Indicators PeopleSoft Customer training Yardi Medical coding Bank Secrecy Act Customer service Collections account management - Largest number of collections accounts managed simultaneously (More than 200 accounts) Human resources Organizational skills Loan servicing School experience Safe work practices Time management Training & development Accounting software Managing clients in a customer support role Computer literacy Financial analysis Managing customer accounts Inside sales Data management Dealership experience Customer retention Home care Collections agent experience Sales Customer relationship building Working with individuals with mental health conditions Financial acumen Consumer protection laws Credit card payment processing Bankruptcy Help desk Microsoft Dynamics 365 Substance abuse ERP systems Canvassing Fair Credit Reporting Act (FCRA) Problem-solving Learning technology Door-to-door Written communication Medical administrative support Achieving sales targets Public relations CMS regulatory compliance Windows Property Management Account management Debt collection negotiation Medical terminology Accounts receivable PHP Database management Cleaning Tenants Medical insurance appeals management Working with the veteran population English Escrow Proofreading Customer inquiry handling Guest relations Epic Training program design for professional development Debt collection phone call Investment management Financial Services Live chat Home health Word processing Patient service Math Patient care Team development EHR systems Finance VPN Debt collection mediation Office phone management Multifamily properties Classroom experience Software troubleshooting Operating systems FNMA Patient billing Patient interaction Guest services Schedule management Phone etiquette Microsoft Word Behavioral health ServiceNow Conflict de- escalation Writing skills Public speaking Ethernet Microsoft Powerpoint Process improvement 10 key typing Customer complaint resolution Customer communication Android Regulatory compliance Executive administrative support Filing Information security Patient monitoring Telemarketing Cash handling Decision making Janitorial experience Hotel experience Skilled nursing facility Remote access software Debt recovery - Highest debt recovery rate achieved (81-90%) Teaching Debt collection payment plan Productivity software Zendesk Maintaining patient confidentiality HVAC Restaurant experience Communication platforms Banking Sage Lending Mortgage industry Objection handling (sales technique) Meeting facilitation Patient collections management Medical collection Virtual client meetings Salesforce Cloud Project management Interpersonal skills Case management Private investigation Attention to detail Employee orientation Phone communication Caregiving Mentoring Credit card accounts Email outreach prospecting Consulting experience Documentation review Medical debt collection accounts Microsoft Teams Benefits administration Debt collection - Debt collection experience (11–15 years) Practicing in a financial advisory role Quality control Experience with children Technical support Working with high schoolers NextGen Communication skills Industry knowledge of financial regulations Management Debt management Revenue cycle management Medical office experience Debits & credits HCPCS Office experience Motivational interviewing Client communication Client interaction via phone calls Systems & applications support Hospitality Okta

Languages

English

Certifications and Licenses

Driver's License

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