Carlesha Moses

• Communicated with patients, providers, and payers to resolve access barriers and maintain treatment continuity.
• Coordinated patient referrals, prescriptions, and follow-up communications across pharmacy and care teams.
• Managed prior authorization requests, insurance verifications, and benefit investigations for specialty medication access.
• Documented case updates, outreach attempts, and resolution details in patient management systems.
• Monitored refill needs and proactively arranged medication coordination to prevent therapy interruptions.
• Tracked case status, escalated urgent issues, and ensured timely completion of coordination tasks.
• Supported process improvements for workflow accuracy, documentation consistency, and service responsiveness.
• Used company software and databases to maintain records of services performed and patient conditions.
• Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.

• Managed benefits verification through outbound and inbound calls. Verifying members insurance and coverage plan. Confirming members' medication, handling, co-pay and co-pay, assistance, handling major medical claims
• Verified insurance eligibility and pharmacy benefits for specialty medication cases, ensuring accurate coverage determination.
• Interpreted payer criteria, prior authorization requirements, and copay structures to support timely patient access.
• Resolved benefit and reimbursement issues by collaborating with payers, prescribers, and internal care teams.
• Reviewed claims responses and rejection codes to identify coverage gaps and correct processing errors.
• Coordinated with patients to obtain missing insurance information and complete verification documentation.
• Monitored complex cases through follow-up, escalating urgent issues to reduce delays in therapy start.
• Maintained up-to-date knowledge on industry regulations, ensuring compliance throughout all benefit verification processes.

• Handling inbound and outbound calls.
• Assisted customers with online banking, resetting passwords, and reviewing billing and loan statements for clarity.
• Activating and sending out new bank cards Assisted with light IT tasks related to online banking systems.
• Resolved complex account inquiries, payment issues, and service requests with accuracy and professionalism.
• Documented customer interactions in CRM systems to maintain clear case history and follow-up.
• Guided clients through online banking, mobile app, and account access troubleshooting.
• Verified customer information and protected confidential data in accordance with compliance requirements.
• Escalated sensitive service concerns to appropriate departments and tracked resolution to completion.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.

• Managed customer service calls, including inbound and outbound communications regarding pharmacy and medical billing.
• Conducted outbound calls for provider services claims coding, addressing pharmacy and medical billing issues.
• Analyzed appeals for accuracy and compliance.
• Managed incoming calls for vision, dental, and pharmacy services.
• Resolved provider inquiries regarding claims, eligibility, and benefits with accurate, timely support.
• Processed complex account issues using internal systems and documented interactions for clear follow-up.
• Verified data accuracy across claims, enrollment, and authorization records to support compliant processing.

• Resolved billing inquiries and clarified account information for customers.
• Mentoring / Floor Walking.
• Provided technical support for users experiencing issues with software.
• Guided new employees on the sales floor to enhance their customer service skills.
• Trainer (Training a 4 week class to get them ready for the floor / calls).
• Going over materials and important information for the job. Making sure all new hires logins worked, making sure hours were corrected.

• Processed customer transactions at checkout.
• Prepared food and beverages according to recipes.
• Processed point-of-sale transactions accurately while handling cash, cards, and gift payments.
• Delivered fast, friendly customer service and resolved register concerns professionally.
• Maintained balanced tills by reconciling cash drawers and verifying transaction accuracy.

• Prepared and cleaned rooms and offices to ensure cleanliness and organization.
• Ensured patient comfort and addressed needs promptly to enhance overall experience.
• Restocked rooms with essential supplies (toilet paper, washcloths, etc.) to ensure readiness for use.

High school diploma

• 3.2 GPA