Briana Crisman
Kuna,ID
Summary
Demonstrative eligibility specialist proudly offering several years' experience assisting others with enrollment and program services. Polished professional known for interactions that are fair, compassionate and respectful. Promoting issue resolution expertise in fast-paced environments.
Overview
9
9
years of professional experience
Work History
Pharmacy Benefits Medicare/Medicaid Specialist
Prime Therapeutics
Kuna, Idaho
07.2024 - Current
- Actively listened to callers, determining call purposes promptly and professionally.
- Resolved customer concerns and identified operational inefficiencies.
- Communicated member eligibility benefits and services as the first line of contact.
- Mentored new staff and assisted in training initiatives.
- Educated providers on claim submission processes and treatment plan protocols.
- Identified crisis calls, providing assistance until resolution with clinicians.
- Informed providers and members about appeal procedures.
- Participated in activities enhancing Care Center performance and culture.
Business Analyst
Your Health Idaho
Boise, Idaho
04.2018 - 06.2021
- Conducted analysis of operational goals and objectives to align with business environment needs.
- Defined project scope, documented requirements, and formulated solutions to achieve operational targets.
- Identified and proposed alternatives to enhance processes and technology within the organization.
- Reviewed business systems to recognize opportunities for process improvements and operational efficiency.
- Completed ad-hoc reporting to support technical and operational requirements as necessary.
- Gathered and documented information from users, partners, and vendors for system enhancements.
- Developed functional business requirements for new software projects and created training procedures.
- Collaborated with IT to ensure compliance with business practices and facilitated User Acceptance Testing.
Reconciliation Lead
Your Health Idaho
Boise, Idaho
03.2017 - 04.2018
- Trained Reconciliation team on quality, productivity, and time management standards.
- Assisted in leading Reconciliation team to identify improvements in effectiveness.
- Tracked inventory and workload to optimize resource allocation.
- Conducted quality reviews of team casework to ensure adherence to standards.
- Processed enrollment discrepancies and performed manual verification tasks.
- Troubleshot complex technical issues and provided updates to external partners.
- Supported escalation of potential system defects based on YHI technology requirements.
- Analyzed consumer and carrier concerns, applying business policy for desired outcomes.
Reconciliation Specialist
Your Health Idaho
Boise, Idaho
11.2016 - 03.2017
- Facilitated reconciliation through effective Q&A assistance and constructive feedback.
- Addressed consumer inquiries regarding insurance enrollment and plan selection options.
- Provided support for agents, brokers, and enrollment counselors with IPA, Navigators, and CACS-related questions.
- Analyzed consumer and carrier concerns to align with business policy requirements.
- Processed enrollment discrepancies and conducted manual verifications efficiently.
- Identified system defects and escalated issues based on process knowledge.
- Conducted thorough research to resolve complex cases effectively.
- Reconciled eligibility data periodically between DHW, Carrier, and YHI.
Consumer Advocate
Your Health Idaho
Boise, Idaho
08.2016 - 11.2016
- Addressed consumer inquiries regarding insurance enrollment and plan selection options.
- Supported agents, brokers, and enrollment counselors with IPA, Navigators, and CACS queries.
- Assisted in processing status changes on agent portals to ensure accurate updates.
- Analyzed consumer and carrier concerns to apply business policy for optimal outcomes.
- Provided periodic floor support to enhance team operations.
- Maintained knowledge of State and Federal ACA regulations to ensure compliance.
- Executed additional assigned duties to support organizational objectives.
Education
High School Diploma -
Richard McKenna Charter High School
Mountain Home, ID05-2004
Skills
- Medicaid policy
- Benefit verification
- Claims processing
- Regulatory compliance
- Data analysis
- Project management
- Customer relationship management
- Team mentoring
- Effective communication
- Crisis management
- Conflict resolution
- Policy analysis
- Process improvement
- Technical troubleshooting
- Time management
Accomplishments
- Achieved 5 yearly Toastie Awards while with Your Health Idaho for outstanding performance.
Timeline
Pharmacy Benefits Medicare/Medicaid Specialist
Prime Therapeutics
07.2024 - Current
Business Analyst
Your Health Idaho
04.2018 - 06.2021
Reconciliation Lead
Your Health Idaho
03.2017 - 04.2018
Reconciliation Specialist
Your Health Idaho
11.2016 - 03.2017
Consumer Advocate
Your Health Idaho
08.2016 - 11.2016
High School Diploma -
Richard McKenna Charter High School
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