Bethany Teagarden
Pittsburgh,PA
Summary
Dynamic and results-driven professional with extensive experience at UPMC Health Ins. specializing in pharmacy claim analysis and prior authorization management. Proven ability to enhance operational efficiency through quality assurance and effective communication. Proficient in Microsoft Excel and dedicated to compliance with HIPAA and CMS regulations, ensuring optimal client outcomes.
Overview
8
8
years of professional experience
Work History
Performant Company
Coordination Of Benefits Analyst
01.2023 - Current
- Working primarily through Excel, reviewed assigned pre-pay or post-pay records, investigated coverage, and determined primacy to maximize revenue for the client’s recovery programs.
- Reviewed eligibility, investigated the policy coverage to determine proper order of benefits and identified trends from payer data to isolate policy details to process appropriately per client and business needs.
- Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance carriers, employers, and/or providers.
UPMC Health Ins. Pharmacy Services
Pharmacy Clinical Review Specialist II
Pittsburgh, PA
05.2021 - 02.2023
- Specialized in pharmacy claim analysis and prior authorization case management for Medicare, Medicaid, and Commercial lines of business, and acting as a conduit of information between the Pharmacy Service Representatives and the clinical staff.
- Assisted with the on boarding of new employees through job shadowing, peer reviews, and quality assurance providing feedback to the trainee and leadership.
- Personally attended to the PA Kids Prescriber Outreach Medicaid project to assist medical professionals in obtaining prior authorizations.
Pharmacy Clinical Review Specialist I
UPMC
01.2018 - 05.2021
UPMC CHILDRENS HOSPITAL
Pharmacy Technician Assoc.
Pittsburgh, PA
01.2017 - 01.2018
- Assisted with sterile and nonsterile medication preparation process, prescription filling, and medication distribution including controlled substances.
- Procured and maintained adequate inventory levels in pharmacy medication stock rooms, automated medication carousels, and automated dispensing machines.
- Maintained compliance with Department of Health, The Joint Commission, and State Board of Pharmacy regulations.
Education
High School Completion -
Kiski Area High School
01.2011
Point Park University
Pittsburgh, PASkills
- Microsoft Office 365 Products: Outlook, Excel, Powerpoint, OneNote
- Quality Assurance
- Medicare and Medicaid
- Customer Service
- Pharmacy Data Entry and Analysis
- Pharmaceutical Operations Assistance
- Adherence to HIPPA and CMS laws and regulations
- Benefits Verification
References
References available upon request.
Timeline
Performant Company
Coordination Of Benefits Analyst
01.2023 - Current
UPMC Health Ins. Pharmacy Services
Pharmacy Clinical Review Specialist II
05.2021 - 02.2023
Pharmacy Clinical Review Specialist I
UPMC
01.2018 - 05.2021
UPMC CHILDRENS HOSPITAL
Pharmacy Technician Assoc.
01.2017 - 01.2018
High School Completion -
Kiski Area High School
Point Park University
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