Summary

Overview

Work History

Education

Skills

Timeline

Annakay Fairclough

Oakland Park,FL

Summary

To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Overview

years of professional experience

Work History

Healthcare Claims Analyst/Claims Testing (Contract

Robert Half (Optum)

Remote

11.2023 - Current

Worked with Agile team to discuss requirements and help prioritize features and user stories
Reviewed eligibility data from clients to ensure the accuracy of transmitted information.
Performed claims testing, benefit enrollment and validations in RxClaim.
Resolved and reported on claims defects.
Updated copay pricing / Accumulator Limits.
Kept up to date with any configuration changes.
Ensured that Audit requests were completed promptly.
Assisted with SFTP file loads and extraction in WinSCP for security purposes.

Healthcare Claims Reporting Analyst (Contract)

Insight Global (Optum)

Fort Lauderdale, FL (Remote)

06.2022 - 11.2023

Extracted claims data from multiple sources to provide accurate monthly/quarterly reporting.
Collaborated with Software Developers/Analysts to automate claims processing on clients with strict SLAs to avoid payouts.
Opened and resolved tickets using Service now.
Assisted with new client onboarding/Implementations.
Reviewed client contracts to ensure that claims are delivered based upon the client's deadlines.
Produced monthly/quarterly reports using advanced Excel spreadsheet functions
Used and modified prewritten SQL queries to extract data from various databases.
Performed QA on claims data to avoid reporting errors.

Benefit Configuration Analyst (Contract)

Cognizant Technologies (CVS)

Fort Lauderdale, United States (Remote)

08.2021 - 06.2022

Updated claim pricing rules, benefit plans, and provider contracts forwarded by the respective departments
Utilized my knowledge of ICD-10/HCPCS to ensure that prescription J-codes are accurate
Made clinical changes to Medicaid/Medicare/Commercial plans for each state as requested by the client.
Utilized EZ query to pull relevant data for the C.I matrix document creation.
Developed and maintained job aids, policies, and process documents
Built and coded new benefit plan designs into the corporation’s claims processing system, RxClaim.
Analyzed client requests and updated accumulators and other plan info. (e.g., formulary, clinical edits, plan coverage, etc.) in Rxclaim.
Created test beds to perform claims testing before going live.
Utilized Salesforce to maintain and track work assignments.
Held meetings to communicate new policies and procedures to appropriate personnel.

Pharmacy Technician

CVS Health

Fort Lauderdale, FL (Remote

09.2017 - 08.2021

Thoroughly skimmed through patient's profile and contact via calls to place medication orders if needed.
Collected Payments and issued refunds.
Assist members by contacting Doctors’ offices via fax or calls for medication refills.
Assisted accounts receivable by collecting payments or issuing refunds to customers.
Answered incoming phone calls and addressed questions from customers and healthcare providers (CVS).
Matched ICD 10 codes to its proper diagnosis for epilepsy orders.
Performed test claims to verify medication coverage.
Entered patient information into Links database.
Checked SAP database to verify if medication is available for shipment.
Resolved medication order issues.
Assisted with other queues when needed.