Cameron Playle
San Antonio,TX
Summary
Results-oriented professional with a Bachelor of Science in Health and currently pursuing a Master's degree in Data Analytics. Leveraging extensive experience across various healthcare role. Proven track record in healthcare operations, coupled with a strong analytical mindset and a passion for leveraging data-driven insights. Seeking to apply diverse skills and expertise in a dynamic data analytics role.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Appeals Analyst
BioPlus Specialty Pharmacy/Elevance
San Antonio, TX
05.2023 - Current
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.
- Conducted research on evidence submitted in support of appeals.
- Translated clinical trial results, patient-reported outcomes data and health economics analysis into written and visual communications.
- Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review
Coverage Determination Specialist
BioPlusBioPlus Specialty Pharmacy/Elevance
San Antonio, TX
01.2023 - 05.2023
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
- Notified ordering providers of denied authorizations.
- Collaborated with internal departments to provide account status updates.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
Medicare Sales Agent
USAA
San Antonio, TX
05.2022 - 12.2022
- Build and maintain relationships with members through an advisory approach to understand members needs
- Document and define members healthcare necessities by asking thorough discovery questions
- Consult with members on Medicare solutions to meet their financial and healthcare needs
- Develop and present product presentations to educate and sell Medicare products
- Create a sales prospect list based on company data and updated it regularly to ensure best leads
- Remained current on latest industry trends by gaining comprehensive knowledge of financial and insurance products, services and best practices.
Medical Operations Coordinator
Catholic Charities
San Antonio, TX
09.2021 - 04.2022
- Data entry of incoming patients medical history into Excel files and electronic medical records
- Report special medical cases to funding source to determine financial demand and analyze monthly budgets with accounting team
- Delegate transportation and interpretation services for over one hundred refugees per week
- Facilitate interdisciplinary collaboration and coordination between case workers and medical staff
- Managed administrative staff and trained new hires on office procedures and policies
Pharmacy Technician
H-E-B plus
San Antonio, TX
07.2017 - 09.2021
- Organized patient medication therapy management files according to company standard operating procedures
- Improved communication between pharmacy and clinics to reduce patient refill time by 17%
- Performed health screenings and provided health and wellness education to community
- Scheduled and coordinated over eight thousand COVID-19 vaccine appointments
IV and Sterile Compounding Technician
CHI St. Joseph Health Regional Hospital
Bryan, Texas
05.2018 - 10.2018
- Tested and calibrated instruments to ensure accuracy and reliability of data.
- Developed detailed reports documenting test results for analysis.
- Performed troubleshooting and repair of equipment in accordance with manufacturer specifications.
Lab Coordinator
NuTech Inc.
College Station, Texas
06.2016 - 12.2016
- Developed and maintained laboratory safety procedures to ensure compliance with all relevant regulations.
- Generated reports outlining data from experiments conducted in the laboratory.
- Trained new employees on proper laboratory techniques and safety protocols.
- Provided technical support to radiopharmaceutical research projects by preparing customized radionuclides for use in laboratory testing.
Education
Master of Science - Data Analytics
The University of Texas At San Antonio
San Antonio, TX05-2025
Bachelor of Science - Health
Texas A&M University
College Station, TX08.2018
Skills
- Python, R, SAS
- Data Visualization, Tableau
- Variance Analysis
- Statistical modeling and methodology
- Machine Learning
- Sentiment Analysis
Languages
Spanish
Professional
Certification
- Certified by the Pharmacy Technician Certification Board (PTCB)
- American Heart Association- CPR and AED Certified
- AHIP License - 2022, 2023
Timeline
Appeals Analyst
BioPlus Specialty Pharmacy/Elevance
05.2023 - Current
Coverage Determination Specialist
BioPlusBioPlus Specialty Pharmacy/Elevance
01.2023 - 05.2023
Medicare Sales Agent
USAA
05.2022 - 12.2022
Medical Operations Coordinator
Catholic Charities
09.2021 - 04.2022
IV and Sterile Compounding Technician
CHI St. Joseph Health Regional Hospital
05.2018 - 10.2018
Pharmacy Technician
H-E-B plus
07.2017 - 09.2021
Lab Coordinator
NuTech Inc.
06.2016 - 12.2016
Master of Science - Data Analytics
The University of Texas At San Antonio
Bachelor of Science - Health
Texas A&M University
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