Berenice Kretzschmar
San Antonio,TX
Summary
Dedicated Clinical Healthcare professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
10
10
years of professional experience
Work History
Clinical Rep II
CVS Caremark
San Antonio, TX
03.2019 - Current
- Web Utilization, Data Entry, Reception Skills
- Ability to multitask, respond to Time Sensitive situations
- Proficient in handling Pharmaceutical Pharmacy Prior Authorizations and Appeals.
- Maintain precise & detailed documentation to be clear and prevent audit situations.
- Possess knowledge of Medical Terminology, Medical diagnostic coding, Clinical requirements, and Medicare B/D Insurance procedures
- Maintain up to date with all Medicare changes to be able to provide only but the Best Healthcare services to Patients & Clients.
- Efficient in People Soft Skills (high understanding and patient levels to ease patient's worries and anxieties on escalated calls)
- Extent knowledge in Formulary & Criteria Quality reviews to be able to address correct letters to communicate information to the
- Patients & Doctors
Quality Assurance Coworker
CGI
San Antonio, TX
09.2015 - 02.2018
- Knowledgeable of GHP Defense process and appeals to better review Quality of work that is being presented to External Clients.
- Data analyzed, enters Data Entry, and submits reports to Track Trends.
- Versatile to back up any GHP QA on workloads, tasks in their absence.
- Committed in taking notes in all Meetings and Implementing New Changes as Business required.
- Internal Client Associates assisting in GHP Intent to Refer (ITR) reviews
- Designate GHP ITR workload for Internal Client Associates to meet deadlines. Prioritize workload and tasks to effectively meet to deadlines in Timely Manner.
- Performed research to assist in development of project scope, define requirements, and propose corrections.
- Flexible to non-standard hours to be of assistance to QA team, Internal, and External Clients.
- Adhere to Company, Department and policies and Training requirements.
- Communication skills to communicate with QA team, Internal, and External Clients. Certifications
- Six Sigma White Belt
- Six Sigma Yellow Belt
- Project Management Essentials
Pharmacy Precert
CVS Caremark
San Antonio, TX
08.2010 - 08.2015
- Possess knowledge of Medical Terminology, Medical diagnostic coding, Clinical requirements, Medicare B/D, and Commercial Insurance procedures
- Proficient in handling Pharmaceutical & Reimbursement Claims, Pharmacy Pre-Certification, and Grievances / Appeals
- Ability to multitask and respond to needs and pressure situations promptly
- Efficient in People Soft Skills (high understanding and patient levels to ease patient's worries and anxieties on escalated calls)
- Extent knowledge in Formulary & Criteria Quality reviews to be able to address correct letters to communicate information to Patients & Doctors.
- Maintain precise & detailed documentation to be clear and prevent audit situations.
- Maintain up to date with all Medicare changes to be able to provide only but quality Healthcare services to Patients & Clients.
Education
Some College (No Degree) - Basics
San Antonio College
San Antonio, TXReal Estate Agent - Real Estate
San Antonio Board of Realtors
San Antonio, TX12.2020
Medical Assisting - Medical Assisting
Career Point College
San Antonio, TX04.2004
High School Diploma -
Fox Technical High School
San Antonio, TX05.1997
Skills
- Customer Service
- Database Management
- Delivery Management
- Customer Records
- Customer Needs Analysis
- Attention to Detail
- Onsite Evaluations
- Problem Solving
- Conflict Resolution
Timeline
Clinical Rep II
CVS Caremark
03.2019 - Current
Quality Assurance Coworker
CGI
09.2015 - 02.2018
Pharmacy Precert
CVS Caremark
08.2010 - 08.2015
Some College (No Degree) - Basics
San Antonio College
Real Estate Agent - Real Estate
San Antonio Board of Realtors
Medical Assisting - Medical Assisting
Career Point College
High School Diploma -
Fox Technical High School