Overview
Work History
Education
Skills
Timeline
RegisteredNurse
Caja  Washington

Caja Washington

Overview

6
6
years of professional experience

Work History

Eligibility Senior Representative

Accredo Specialty Pharmacy
08.2021


  • Increased customer satisfaction, providing timely and thorough responses to all inquiries received through various channels.
  • Streamlined application review process for faster turnaround times and higher approval rates.
  • Maintained in-depth knowledge of federal, state, and local regulations to accurately assess applicant eligibility for programs.
  • Expedited resolution of escalated cases, liaising with appropriate parties to resolve discrepancies or clarify information.
  • Demonstrated commitment to data privacy by adhering strictly to security protocols when handling confidential applicant information.
  • Managed high-volume caseloads efficiently under tight deadlines while maintaining accuracy and attention to detail throughout the entire process.
  • Supported continuous process improvements by participating in focus groups, committees, and special projects aimed at enhancing the department''s operations.
  • Contributed significantly towards positive audit results from regulatory agencies by ensuring complete adherence to guidelines during eligibility determination processes.
  • Improved client satisfaction by efficiently processing eligibility applications and addressing inquiries.
  • Reduced processing errors, implementing stringent quality control measures for application reviews.
  • Assisted clients with completion of applications and paperwork.
  • Communicated with people from various cultures and backgrounds on referral process.
  • Obtained insurance processing information from patients and doctor’s office's.

Verified insurance details directly with commercial and government insurance plans.

Patient Care Advocate

Accredo
05.2017 - 08.2021
  • Developed strong relationships with local pharmacies to expedite prescription refills and prevent gaps in medication therapy.
  • Demonstrated empathy toward diverse patient populations, building trust through compassionate interactions.
  • Enhanced patient satisfaction by addressing concerns and providing clear communication on treatment plans.
  • Resolved problems with communication and billing to foster seamless services.
  • Managed effective communication between patients and providers by serving as a liaison for questions or concerns.
  • Provided emotional support to patients and families, fostering a positive atmosphere during challenging situations.
  • Completed documentation of care, hospital actions, and patient activities.
  • Stayed calm under pressure to and successfully dealt with difficult situations.
  • Verified patient insurance eligibility and entered patient information into system.
  • Provided excellent customer service to patients and medical staff.
  • Resolved customer complaints using established follow-up procedures.
  • Helped address client complaints through timely corrective actions and appropriate referrals.
  • Responded to inquiries by directing calls to appropriate personnel.
  • Processed payments using cash and credit cards, maintaining accurate records of transactions.

Data Entry Clerk

Nosco
05.2016 - 02.2017
  • Completed data entry tasks with accuracy and efficiency.
  • Followed established procedures to enter and process data correctly.
  • Organized, sorted, and checked input data against original documents.
  • Scanned documents and saved in database to keep records of essential organizational information.
  • Entered data into various computer systems accurately using Microsoft Office Suite.
  • Verified accuracy of data entered into system to produce error-free reports.
  • Reduced turnaround time for projects by consistently meeting or exceeding deadlines while maintaining high-quality work output.

Benefit Service Representative

Aon Hewitt
10.2015 - 04.2016
  • Participated in benefit plan audits, ensuring accuracy and compliance with legal requirements.
  • Organized benefits information sessions to keep employees informed about their options and any policy updates.
  • Improved client satisfaction by efficiently addressing and resolving benefits-related inquiries.
  • Streamlined benefits enrollment process for faster and more accurate submissions.
  • Ensured compliance with federal and state regulations by maintaining up-to-date knowledge of benefit laws and guidelines.
  • Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
  • Implemented open enrollment system to streamline benefits processes for employees.

Education

Data Analyst - Career And Technical Education

Pathstream

Pharmacy Tech

William Rainey Harper College
Palatine, IL

Skills

  • Claims processing
  • Documentation
  • Healthcare industry
  • Eligibility determination
  • Application review
  • Problem-solving
  • Time management
  • Effective communication skills
  • Attention to detail
  • Problem-solving abilities
  • Multitasking
  • Critical thinking
  • Active listening

Timeline

Eligibility Senior Representative

Accredo Specialty Pharmacy
08.2021

Patient Care Advocate

Accredo
05.2017 - 08.2021

Data Entry Clerk

Nosco
05.2016 - 02.2017

Benefit Service Representative

Aon Hewitt
10.2015 - 04.2016

Data Analyst - Career And Technical Education

Pathstream

Pharmacy Tech

William Rainey Harper College
Caja Washington