GABRIELLE HOWARD
Raleigh,NC
Summary
Highly analytical healthcare professional, combining more than 10 years of work in Health Care with proficiency in data safety, seeking to increase productivity within processing and reporting. Diligent and motivated to improve processes, streamline operations, and increase revenue. Possessing excellent judgment and communication skills with deep understanding of business operations.
Overview
12
12
years of professional experience
Work History
Operations Analyst
IntegriChain Incorporated
Durham , NC
05.2019 - Current
- Perform data validation and processing of pharmaceutical claims that support a variety of business processes for a large base of pharmaceutical manufacturers
- Setup and maintenance of client contracts and memberships for ongoing BPO (Business Process Outsourcing) Services
- Point of Contact (POC) for clientele in various states
- Manage and coordinate operational processes for Tricare and Coverage Gap
- Perform calculations required through Excel to provide Drug Rates Per Unit and Claims Level Details
- Generated reports of findings through Model N to help manage over 300 + Medicaid Rebates per quarter
- Report trend insights, client interaction and support to contracted clients
- Reporting and Data reconciliation for claims level detail, quarterly reports, and documentation
- Assist in various reporting activities required for client compliance in various government programs
- Perform under tight deadlines and balance multiple client assignments
Reimbursement Case Manager
TrialCard Incorporated
Morrisville, NC
10.2018 - 05.2019
- Completes pharmacy and medical investigations to submit required documentation for payer/plan review, for prior authorizations, step edit identification, and appeals according to (SOP) standard operations procedures
- Manages 10-20 pharmaceutical priority caseloads for clients in various regions per day
- Receive and document calls, faxes, and emails from sites and sources to complete investigations
- Generate reports and queries sent to clients and providers within assigned deadlines
- Meet all specific program productivity metrics as set forth by the individual project
- Perform data entry to coordinate access to therapies, and conduct appropriate follow up and facilitates access to appropriate support services
- Contribute to various functional teams including data management, medical monitoring, and pharmacy coordinators
Resolution Coordinator
Blue Cross and Blue Shield of North Carolina/Manpower
Durham, NC
01.2018 - 01.2018
- Analyzes and coordinates all aspects of 20-30 appeals processes daily to ensure compliance with medical necessity criteria for provider appeals.
- Determines the validity of incoming appeals and make critical decisions to provide rationale for the valid and non-valid decision
- Provide written response member education regarding appropriate submission of inquiries
- Ensures the compliance with medical necessity criteria, Corporate Medical Policy, contract provisions, NC DOI, legislative and NCQA requirements
- Coordinates and assigns dispositions of Level 1 appeals
- Performed compliance audits to ensure adherence to NC and federal regulations relating to documentation and reporting
Medical Communication Specialist
PPD
Morrisville, NC
01.2016 - 01.2017
- Identify and document adverse events and product complaint in database systems to ensure assigned deadlines
- Processed safety data according to polices and procedures of SOP
- Triage and process safety data through databases such at Salesforce, Argus, and Trackwise.
- Consistently maintain departmental goals meeting and exceeding productivity metrics
- Generated medical and technical reports via FDA and SOP protocol
- Processed fulfillments (e.g., email, fax, mail)
- Cross trained and mentor new team members on specific operational processes
- Maintained knowledge of policies and procedures including, products, SOPS, protocols, GCPs, and FDA regulations
- Worked closely with internal and external client contacts to resolve complex customer and HCP issues
Benefits/Financial Associate
Fidelity Investments
Durham, NC
09.2011 - 09.2015
- Processed and monitored benefit enrollments in the Oracle database
- Determined patient's eligibility for annual and life changing event statuses
- Assessed and collected data through customers for accurate enrollments
- Assisted with technical issues through online planning and enrollments.
- Analyzed operational performance of mutual funds through financial planning
- Measured performance and compared overall rate of return for funds within a client's portfolio.
- Completed financial research and transitional budgeting of multi-million-dollar accounts.
- Consulted with business unit for investment analysis of present and future changes
- Provided project management and conducted formal training sessions to new staff.
- Resolved benefits claims with third party vendors
Mental Health Case Manager
Fellowship Health Resources
Raleigh, NC
05.2007 - 08.2010
- Developed a treatment plan, taught modules, monitored treatment, and planned intervention in accordance with the Person-Centered Plan
- Facilitated groups, taught social skills training classes, and actively organized improvement initiatives
- Maintained clinical records, transported clients, and sustained client relationships
- Lead meetings concerning consumer growth and observation
Education
MBA -
University of Phoenix
Raleigh NC 2010
Bachelor of Science - Criminal Justice
East Carolina University
Greenville NC 2002
Skills
- Data Validation
- Perform Calculations
- Database Analysis
- Point of Contact (POC)
- Microsoft SharePoint
- Training/mentoring
- Model N processing
- Compliance with Healthcare regulations for SOP and FDA
- Facilitation
- Time Management
- Report generation
- Cross-functional teamwork
Timeline
Operations Analyst
IntegriChain Incorporated
05.2019 - Current
Reimbursement Case Manager
TrialCard Incorporated
10.2018 - 05.2019
Resolution Coordinator
Blue Cross and Blue Shield of North Carolina/Manpower
01.2018 - 01.2018
Medical Communication Specialist
PPD
01.2016 - 01.2017
Benefits/Financial Associate
Fidelity Investments
09.2011 - 09.2015
Mental Health Case Manager
Fellowship Health Resources
05.2007 - 08.2010
MBA -
University of Phoenix
Bachelor of Science - Criminal Justice
East Carolina University
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