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
7
7
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.
Education
Certificate - Business Analytics
University of South Florida
09.2023
Bachelor of Science - Health Information Management
University of Arizona Global
03.2023
Associate of Science - Medical Office Administration/Billing & Coding
City College - Fort Lauderdale
01.2020
Skills
- Claims Adjudication/Testing
- Service Now
- Nextgen/Epic
- QA/UAT Testing
- Advanced Excel Skills
- Insurance claims processing/ Insurance Verification
- ICD-10, CPT, and HCPCS
- Salesforce/SQL/Sharepoint
- Revenue cycle
- Licensed Pharmacy Technician
Timeline
Healthcare Claims Analyst/Claims Testing (Contract
Robert Half (Optum)
11.2023 - Current
Healthcare Claims Reporting Analyst (Contract)
Insight Global (Optum)
06.2022 - 11.2023
Benefit Configuration Analyst (Contract)
Cognizant Technologies (CVS)
08.2021 - 06.2022
Pharmacy Technician
CVS Health
09.2017 - 08.2021
Certificate - Business Analytics
University of South Florida
Bachelor of Science - Health Information Management
University of Arizona Global
Associate of Science - Medical Office Administration/Billing & Coding
City College - Fort Lauderdale