Ashley Gall
Pensacola
Summary
Detail-oriented Pharmacy Professional with 9 years of experience in retail and specialty settings, focusing on benefit verification, insurance processing, and patient access support. Expertise in resolving complex coverage issues, interpreting payer requirements, and ensuring accurate documentation. Committed to enhancing patient satisfaction and streamlining processes for timely access to therapy while pursuing a BA in Professional Writing to further enhance communication skills.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Benefits Verification Specialist
BioPlus Specialty Pharmacy
Altamonte Springs
03.2021 - Current
- Interpreted complex specialty‑pharmacy benefits to determine PA requirements, coverage limitations, and payer‑specific documentation needs.
- Collaborated with prescribers, health plans, and pharmacies to gather missing clinical information and ensure complete, authorization‑ready case files.
- Conducted thorough investigations into eligibility, prior authorization status, appeals, and reimbursement pathways to support timely therapy access.
- Stayed current on evolving payer policies, medical necessity criteria, and PA workflows to ensure accurate benefit interpretation and compliant documentation.
- Resolved complex benefit discrepancies through analytical problem‑solving, preventing delays and improving case turnaround times.
- Produced precise, audit‑safe documentation that supported downstream PA and appeals teams and ensured compliance with internal quality standards.
Senior, Licensed Pharmacy Technician
Walgreens Pharmacy
Lake Mary
10.2017 - 03.2021
- Verified prescription and benefit accuracy by entering patient and medication information with precision to support correct billing and prevent claim denials.
- Collaborated with prescribers to clarify clinical details, verify prescription accuracy, and support timely medication fulfillment.
- Addressed coverage questions, reimbursement concerns, denials, and appeals by resolving benefit-related issues through patient and provider calls.
- Interpreted pharmacy and medical benefits and communicated cost‑share details such as deductibles, co‑pays, and out‑of‑pocket responsibilities.
- Ensured billing compliance by monitoring patient records and verifying alignment with insurance plan requirements.
- Maintained organized accountability records to ensure documentation compliance with payer and pharmacy standards.
- Delivered high-quality service to patients and healthcare professionals, enhancing pharmacy operations and supporting positive patient outcomes.
Education
Bachelor of Arts - Professional Writing
Southern New Hampshire University
Manchester, NH, US06-2026
Skills
- Insurance Verification
- Diagnostic coding
- Medicare/Medicaid Processes
- Diagnostic Codes (ICD‑10, HCPCS, NDC)
- Medical Terminology
- Claims Processing
- Patient communication
- Audit documentation
- Policy adherence
- Problem resolution
Certification
- Florida Board of Pharmacy License, RPT78554
- Pharmacy Technician Certification Board, 30095642
Performance Highlights
- Managed 30–40 specialty cases daily while maintaining high accuracy in benefit verification and documentation.
- Earned recognition for strong knowledge of PBM, medical, Medicare, and Part B billing workflows.
- Demonstrated oncology proficiency by accurately interpreting complex benefit requirements for high‑cost oncology therapies.
- Maintained exceptional attendance and reliability, earning formal recognition for consistent performance and workflow dependability.
Timeline
Benefits Verification Specialist
BioPlus Specialty Pharmacy
03.2021 - Current
Senior, Licensed Pharmacy Technician
Walgreens Pharmacy
10.2017 - 03.2021
Bachelor of Arts - Professional Writing
Southern New Hampshire University