Ciara Kirkland
Lithonia,GA
Summary
Dedicated Administrative and Healthcare Support Professional skilled in managing time-sensitive documentation and ensuring data accuracy. Prioritizes tasks effectively while maintaining compliance and offering support to individuals with mental health needs. Recognized for delivering organized, high-quality work with minimal supervision.
Overview
10
10
years of professional experience
Work History
Case Manager
Valeris
09.2024 - Current
- Managed case-related records, updated information, maintained organized documentation to ensure accurate client support.
- Review and process time-sensitive documentation while ensuring accuracy, completeness, and compliance with established guidelines.
- Verify prior authorization information and review documentation to support healthcare service requests.
- Monitored pending cases and documentation deadlines to facilitate timely processing and resolution.
- Communicated with relevant parties to obtain missing information, resolving documentation issues to enhance case management.
- Review information for discrepancies, missing documents, and errors requiring correction or follow-up.
- Reviewed claim files for accuracy, completeness, and compliance.
- Verified claim data correctness in preparation for processing.
- Communicated with adjusters, providers, and customers about claim updates.
- Interpreted policy terms to support claim decisions and processing.
- Escalated complex claims to supervisors for further review.
- Protect confidential patient information and follow applicable privacy requirements.
Patient Care Coordinator
Walmart Specialty Pharmacy
09.2022 - 01.2024
- Entered prescription data into pharmacy systems, ensuring accuracy and compliance for optimal patient outcomes
- Review prescriptions and translate information into system codes
- Ensure fulfillment of specialty pharmacy orders
- Follow Medicare, Medicaid, and regulatory guidelines
- Monitor workflow and resolve processing issues
- Maintain quality standards and inventory accuracy
- Monitored workflow and resolved processing issues to maintain seamless operations and timely medication delivery
- Executed data entry to maintain records, printing, scanning, and documentation filing
ACS Pharmacy – CVS Health
01.2017 - 09.2022
- Performed high-volume data entry with focus on accuracy
- Printed, scanned, filed, and distributed documentation
- Reviewed documents for accuracy and corrected discrepancies
- Trained new hires on systems and procedures
- Coordinated with providers and insurance companies
- Processed claim rejections and resolved issues
- Completed insurance and copay assistance applications
- Tracked productivity metrics and maintained organized records
Education
Apopka High School
Apopka, FLSkills
- Team collaboration
- Attention to detail
- Time-sensitive documentation
- Case documentation management
- Workflow organization
- Claim processing
- Policy compliance
- Critical thinking
- Quality assurance
- Deadline management
- Confidential handling
Timeline
Case Manager
Valeris
09.2024 - Current
Patient Care Coordinator
Walmart Specialty Pharmacy
09.2022 - 01.2024
ACS Pharmacy – CVS Health
01.2017 - 09.2022
Apopka High School