Carissa Twomey
Durham,ME
Summary
Driven and goal-oriented professional with a comprehensive background at Martin's Point Healthcare, excelling in roles that demand exceptional customer service and strong multi-tasking abilities. Demonstrated expertise in data entry accuracy and a proven track record in mentoring and setting goals for myself. Eager to continue to grow and develop within Martin's Point and to explore the new world of appeals.
Overview
9
9
years of professional experience
Work History
Provider Inquiry Rep I
Martin's Point Healthcare
09.2022 - Current
- Answers incoming calls from providers, pharmacies, and insurance companies
- Researches insurance claim denials and provides information and steps for resolution to providers
- Provides both USFHP and GA benefits and authorization requirements to providers
- Educates providers on dispute and or appeals process for both USFHP and GA plans
- Assists providers through usage and troubleshooting of our provider portal
- Works collaboratively with multiple departments within company including but not limited to: claims, pharmacy administration, appeals, audit and recovery, member services, health management department and finance to assist providers with their needs
- Sends research requests for any issues that are not able to be resolved with provider on the phone at that current time
- Comfortable using multiple computer programs within MP including but not limited to: microsoft word, excel, powerpoint, qnxt, trucare, td bank, imagenet, sharepoint, sso, microsoft teams
- Mentors new rep I's on all 3 PI lines when we hire new team members
- Assists our research team with billing checklists to get calls ready for research team to make
- Manages call tracks in between calls
Certified Pharmacy Technician Supervisor
Martin's Point Healthcare
06.2021 - 09.2022
- Developed and maintained schedule for pharmacy technicians based on workflow and needs
- Assessed workflow on a daily basis and adjusted schedule and technician assignments as needed
- Lead weekly team huddles
- Lead weekly OFI meetings to gather feedback from technicians and implement new procedures to help develop more efficient workflows
- Monitored accuracy of processed pharmacy claims and data entry
- Monitored time off requests
- Provided coaching opportunities and gave performance feedback to all team members
- Implemented training procedures for new team members
- Lead 1:1s with team
- Assisted with regular workflow when needed
- Wrote / presented NCQA reports for pharmacy
- Interviewed and hired new staff
- Handled and resolved customer escalations
Pharmacy Technician Team Lead
Martin's Point Healthcare
06.2020 - 06.2021
- Lead the processing team
- Data entry for prescriptions
- Handled pharmacy prior authorizations and submitted them to pharmacy administration department
- Followed up with members regarding prior authorization statuses
- Filled prescriptions
- Shipped prescriptions
- Implemented OFIs
- Assisted supervisor with training new members
- Assisted call center in meeting metrics / implementing new procedures to make call center more efficient
- Lead team by example
- Helped supervisor with scheduling
- Reported all feedback and concerns to supervisor
Mail Order Pharmacy Technician
Martin's Point Healthcare
02.2015 - 06.2020
- Answered incoming phone calls and addressed questions from customers and healthcare providers
- Stocked, labeled, and inventoried medications
- Filled prescriptions
- Data entry of prescriptions
- Shipped presciptions
- Filed prescriptions
- Participated in team huddles
- Made outgoing calls to provider's offices regarding obtaining medication refills for patient's medications
Education
Bachelor of Science - Athletic Training
University of Tampa
Tampa, FL05.2011
Skills
- Excellent customer service
- Strong multi-tasking ability
- De-escalation skills
- Teamwork
- Problem Solving
- Bringing to attention opportunities for improvement
- Proficient in typing
- Fast learner
- Always eager to learn new skills
- Accepting of feedback and constructive criticism
- Passion for a job well done
- Training experience
- Mentoring experience
- Knowledge of USFHP and GA plans
- Easy to get along with
- Comfortable with many departments
- Data entry accuracy
- Goal oriented
Timeline
Provider Inquiry Rep I
Martin's Point Healthcare
09.2022 - Current
Certified Pharmacy Technician Supervisor
Martin's Point Healthcare
06.2021 - 09.2022
Pharmacy Technician Team Lead
Martin's Point Healthcare
06.2020 - 06.2021
Mail Order Pharmacy Technician
Martin's Point Healthcare
02.2015 - 06.2020
Bachelor of Science - Athletic Training
University of Tampa
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