Davasha Peters
Pittsburgh,PA
Summary
Compassionate Case Manager adept at handling high caseloads without sacrificing quality of care. Offers excellent problem-solving, conflict resolution and communication abilities. Strong collaborator and committed to leading and inspiring a team to achieve shared goals.
Overview
6
6
years of professional experience
Work History
Case Manager
ConnectiveRx
01.2023 - Current
- Takes the lead to manage the Care Coordination cases assigned day by day. Effectively managing cases and hitting performance metrics for production and quality. Strong understanding of the case management process along the healthcare continuum; advocating and contributing to the patient’s positive journey.
- Responsible for assigning casework and assisting other agents with work related and process questions. Assisting with escalations, and special projects.
- Providing assistance with creating SOPs and Job Aides to help train new hires, as well as the existing teammates on updated processes and flows. Knowledgeable on benefit-related questions regarding insurance information, work processes, and program information.
- Demonstrate a leadership role by demonstrating accountability for action plan execution, and energetically drives for success and results. I effectively shares knowledge and support team members through training, case studies, and for complex cases.
- Provide support to patient and physician concerns; obtains insurance approval/denials and/or appeals for therapy and proactive plans to avoid the potential of delayed coverage by working with the patient, family, insurance company, or physicians. Assists HCP with processing applications for Copay Assistance/Reimbursement and Patient Assistance Programs. Assists with ordering/triaging prescriptions for HCP.
- Collaborate and maintain consistent communications with Field Reps, Provider offices, and Insurance companies. Using tact and independent judgment to balance patient and physician needs remembering the company values and guidelines of the program. Multitasking to coordinate, and advocate for options and services to meet the client’s needs to achieve one stop resolutions.
- Identify and report adverse events, product quality complaints and special reporting situations in required timeframes.
- Maintain certification in all client-based requirements and up to date knowledge and training across all systems utilized by client teams. To further skills I am actively taking part in the Mentorship Program.
CPR Instructor/Co Owner
Fragile Heart CPR LLC
03.2020 - Current
- Assisted in recruiting, and hiring CPR/BLS instructors. I have trained and guided new team members to maintain high productivity and performance metrics. Preparing our new instructors with mandated training manuals and assessments that align with the American Heart Association and Red Cross. I have analyzed individualized instruction and identified opportunities for additional training.
- Track instructors and students attendance, assist with payroll, scheduling instructors for classes, collecting sign in sheets from instructors after classes.
- Provided immediate and constructive feedback to instructors and students individually and as group. Supervised groups of 10-12 students when running a class.
- Developed an excel spreadsheet budget based upon costs and fees for successfully operating business, ordering equipment, etc
- I have proven the ability to learn quickly and adapt to new situations. During the pandemic I implemented new training online courses to serve students. I had to create and distribute a new course syllabus and learning objectives that facilitated remote learning base off the American Heart Association and Red Cross new manuals.
- Collaborated with PALS/ACLS instructors to implement best practices to enhance student learning. I have cultivated and strengthened lasting relationships in the BLS/CPR realm by demonstrating respect, friendliness and willingness to help wherever needed.
Team Lead Patient Support
ConnectiveRx
05.2022 - 01.2023
- Conducted training, created job aids and mentored team members to promote productivity, accuracy, and commitment to friendly service. Responded to team members when questions arise.
- Worked different stations to provide optimal phone coverage to meet production goals and SLA.
- Built strong relationships with Field Representatives through positive attitude and attentive responses. Developed an escalation tracker for buy and bill program to improve our organization.
- Created Service tickets and Jira Tickets for issues involving the adjudication software.
- Participated in meetings with IT Department working on special projects. Collaborated with ConnectiveRX financial department with Buy and Bill claims. Assisted in meetings with Field Reps and Clients to communicate issues and/or processes that need changed or updated.
Sr. Claim Specialist
ConnectiveRx
06.2021 - 05.2022
- Educated in Buy and Bill programs. Worked in the Nessce software, Eagleforce, and Cimplicity Portal creating manual claims using EOBs, reviewing, and processing claims.
- Handling escalation emails that includes following up with Patients, Provider offices and Field Reps on unresolved issues dealing with claims.
- Responded to inquiries by answering questions, providing information and directing Provider office's to appropriate resources.
- Educated new hires on proper use of processes and systems.
- Provided input and feedback to Supervisor, Quality Management and Training (among others) to improve processes, procedures, and training.
Patient Support Specialist
ConnectiveRx
11.2019 - 06.2021
- Answered inbound calls from patients promptly to avoid on-hold wait times meeting SLA for the program.
- Delivered exceptional customer service to every patient and specialty pharmacy by sharing extensive knowledge of our services and creating welcoming, positive experiences.
- Actively listened to patients, handled concerns quickly and escalated major issues to supervisor.
- Handled billing and payment issues, resolving disputes properly with specialty pharmacies.
- Made outbound calls to Payers and Pharmacy Benefit Manager in order to verify patient insurance coverage and identify available Medical and Pharmacy benefits.
Home Health Care Aide
Comfort Keepers Home Care
02.2018 - 12.2019
- Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
- Assisted patients with handling daily chores and errands by transporting to appointments, cleaning personal spaces, and purchasing supplies.
- Provided patients with assistance in completing daily tasks, reducing daily burden on family members.
Customer Service Representative
Dial America
03.2019 - 11.2019
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Answered constant flow of customer calls with minimal wait times.
- Answered customer telephone calls promptly to avoid on-hold wait times.
Education
Some College (No Degree) -
CCAC of Allegheny
Pittsburgh, PAHigh School Diploma -
Northgate Highschool
Pittsburgh, PA06.2013
Skills
- Training Team Members
- Customer service experience
- Research and Reporting
- Multitasking and Organization
- Judgement and Decision Making
- Proficient with computer software
Timeline
Case Manager
ConnectiveRx
01.2023 - Current
Team Lead Patient Support
ConnectiveRx
05.2022 - 01.2023
Sr. Claim Specialist
ConnectiveRx
06.2021 - 05.2022
CPR Instructor/Co Owner
Fragile Heart CPR LLC
03.2020 - Current
Patient Support Specialist
ConnectiveRx
11.2019 - 06.2021
Customer Service Representative
Dial America
03.2019 - 11.2019
Home Health Care Aide
Comfort Keepers Home Care
02.2018 - 12.2019
Some College (No Degree) -
CCAC of Allegheny
High School Diploma -
Northgate Highschool