Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

Eleanor Kelley

Douglasville,Ga

Summary

Motivated professional currently pursuing Pharmacy Technician career. I am licensed in the state of Georgia. I have over 8 years of experience talking with healthcare professionals as well as members. I have extensive knowledge in medical processes, medical insurance and medical claims.

I have a strong background in retail environments with outstanding customer service, problem-solving and sales skills. Excited to launch career with Walgreens.

Overview

11
11
years of professional experience

Work History

Appeals Coordinator Sr.

United Healthcare
06.2022 - Current
  • Monitored changes in regulations or policies, updating internal procedures accordingly to maintain compliance.
  • Coordinated with medical professionals and subject matter experts for case reviews, obtaining necessary clarification for accurate decision making.
  • Created, composed and maintained appeal response templates.
  • Coordinated with medical professionals and subject matter experts for case reviews, obtaining necessary clarification for accurate decision making.
  • Collaborated with cross-functional teams, resulting in improved communication and quicker resolutions.
  • Maintained comprehensive knowledge of regulatory guidelines to ensure compliance within the appeals department.
  • Organized and managed appeals caseloads, prioritizing high-priority cases for timely resolution.
  • Coordinated with senior specialist to compose appeal responses.
  • Contributed to a positive work environment by sharing best practices among colleagues; improving overall team performance.
  • Enhanced appeal resolution rates by thoroughly reviewing and analyzing case documentation.
  • Conducted detailed audits on case files, ensuring accuracy and completeness of information for better decision making.
  • Participated in regular meetings with management to provide updates on case status and discuss potential improvements in processes.

Appeal Rep. - Medicare and Retirement Operations

United Healthcare
09.2016 - 06.2022
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
  • Maintained high levels of accuracy in all written correspondence, ensuring clear communication with relevant stakeholders during the appeals process.
  • Increased customer satisfaction ratings through timely follow-up on appeal status inquiries, providing accurate information and addressing concerns promptly.
  • Verified client information by analyzing existing evidence on file.

Data Integrity Specialist

Southwest Business Corporation
01.2015 - 09.2016
  • Maintained database systems to track and analyze operational data.
  • Developed comprehensive reports, enabling management to make informed decisions based on accurate data analysis.
  • Identified key performance metrics for ongoing monitoring of data integrity efforts and continuous improvement opportunities.
  • Contributed significantly towards maintaining the confidentiality, integrity, and security of sensitive organizational data through robust privacy policies implementation.
  • Supported regulatory compliance efforts with meticulous documentation and adherence to industry standards.

Customer Service Representative

Southwest Business Corporation
08.2014 - 01.2015
  • Followed up with customers about resolved issues to maintain high standards of customer service.
  • Increased efficiency and team productivity by promoting operational best practices.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Tracked customer service cases and updated service software with customer information.

Lab Assistant

UTSA Office of Information Technology
01.2014 - 05.2014
  • Assisted The University of Texas at San Antonio faculty, staff, students, contractors, parents, and public with computer and software issues.
  • Operated first line of support for software.
  • Operated multi-line phones and assisted with computer issues; installed updates, software, fixed computer software issue, detected viruses, and escalated work orders.

Intern

San Antonio Police Department
01.2014
  • Participated in patrol with SAPD officers, observed in dispatch center, investigated disturbances; learned the construction of crime scene with CSI on location; secured and analyzed crime scenes by talking to officers dispatched to scene, processed crime scene, observed sketching and photographing of crime scene, marked evidence, collected fingerprints and drug tests; interviewed witnesses, took victims’ statements, reviewed evidence, and transcribed reports

Data Integrity Specialist

Southwest Business Corporation
01.2015 - 01.2016
  • Handled extensive research with multiple escrow accounts; handled several client accounts; researched documents to ensure the highest level of data quality; handled tasks with special projects and leadership responsibility on the team

Sales Associate Specialist - Digital Imaging

Best Buy
12.2012 - 08.2014
  • Developed a comprehensive understanding of product offerings and effectively communicated this knowledge to potential buyers, helping them make informed decisions.
  • Worked closely with shift manager to solve problems and handle customer concerns.
  • Increased sales revenue by building strong customer relationships and providing tailored product recommendations.
  • Used in-store system to locate inventory and place special orders for customers.

Education

B.A. - Criminal Justice

The University of Texas At San Antonio
01.2014

Skills

  • Outstanding communication skills
  • Process Improvement
  • Medical Terminology Familiarity
  • Medical Terminology
  • Data Integrity
  • Multitasking and Organization
  • Process Analysis
  • Medical coding knowledge
  • Strong analytical skills
  • Microsoft Office
  • Data entry proficiency
  • Decision-Making

Additional Information

Active Georgia Pharmacy Technician License issued by the Georgia Board of Pharmacy

Timeline

Appeals Coordinator Sr.

United Healthcare
06.2022 - Current

Appeal Rep. - Medicare and Retirement Operations

United Healthcare
09.2016 - 06.2022

Data Integrity Specialist

Southwest Business Corporation
01.2015 - 09.2016

Data Integrity Specialist

Southwest Business Corporation
01.2015 - 01.2016

Customer Service Representative

Southwest Business Corporation
08.2014 - 01.2015

Lab Assistant

UTSA Office of Information Technology
01.2014 - 05.2014

Intern

San Antonio Police Department
01.2014

Sales Associate Specialist - Digital Imaging

Best Buy
12.2012 - 08.2014

B.A. - Criminal Justice

The University of Texas At San Antonio

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