Janae Offutt
Nashville,TN
Summary
Case Manager with extensive experience in claims processing, benefits verification, and insurance authorization. Proficient in managing complex claims, resolving CPT code discrepancies, and ensuring timely patient authorizations. Demonstrated ability to communicate effectively with clients and healthcare professionals regarding insurance inquiries and billing issues. Strong problem-solving skills complemented by a commitment to delivering exceptional customer service.
Experienced with operational management, team leadership, and customer service excellence. Utilizes strategic planning and problem-solving to enhance store efficiency. Track record of achieving sales targets and maintaining high standards in store presentation.
Overview
9
9
years of professional experience
Work History
Store Manager
MAPCO
12.2024 - Current
- Managed daily operations to ensure smooth functioning of the store, maintaining a clean, safe environment for customers and employees.
- Managed inventory control, cash control, and store opening and closing procedures.
- Addressed customer complaints promptly and professionally, resolving issues to maintain positive relationships with clientele.
- Managed store employees successfully in fast-paced environment through proactive communication and positive feedback.
Store Manager
Dollar General
06.2024 - 02.2025
- Managed daily operations to ensure smooth functioning of the store, maintaining a clean, safe environment for customers and employees.
- Managed inventory control, cash control, and store opening and closing procedures.
- Addressed customer complaints promptly and professionally, resolving issues to maintain positive relationships with clientele.
- Managed store employees successfully in fast-paced environment through proactive communication and positive feedback.
- Assisted with hiring, training and mentoring new staff members.
Pharmacy Specialist
CVS Caremark
08.2021 - 09.2024
- Answer patient questions with compassion and expertise
- Deliver clinical excellence with each patient encounter
- Provide high-quality, personalized care and support
- Provide high-quality, personalized care and support.
- Enhanced patient care by accurately filling prescriptions and providing medication counseling.
- Educated patients on the importance of medication adherence for better health outcomes.
- Ensured compliance with federal, state, and local regulations by adhering strictly to pharmacy laws and safety protocols.
- Coordinated closely with insurance companies to resolve billing issues efficiently, reducing financial burdens on patients.
- Participated in continuing education programs to stay current on industry trends, best practices, and emerging therapies.
Credentialing Specialist
AMN Healthcare
07.2021 - 01.2022
- Responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid.
- Collaborated with healthcare providers to gather necessary information for accurate credentialing decisions.
- Managed multiple priorities effectively, resulting in the on-time completion of credentialing tasks for numerous providers simultaneously.
- Conducted audits of provider files, ensuring all necessary documents were up-to-date and compliant with regulatory requirements.
- Enrolled providers and Medicaid, Medicare, and private insurance plans.
Verification Specialist
Navient Healthcare
02.2021 - 05.2021
- To make and take calls to employers for the purpose of verifying information stated by an applicant on his/her job application
- Communicate effectively and proficiently to all parties involved in attaining verification information.
- Prioritized workload efficiently, managing multiple cases simultaneously without compromising on quality or accuracy.
- Participated in regular performance reviews, using constructive feedback as an opportunity for growth and development within my role as a Verification Specialist.
- Maintained a high level of professionalism when interacting with external parties during the verification process.
Customer Service Rep
CVS - Nashville, TN
08.2016 - 04.2021
- Often charged with answering questions regarding premium payment and billing
- Responsible for explaining statements, helping customers understand various pieces of insurance paperwork and answering questions regarding insurance premium payments.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
Appeal Associate
Cigna - Nashville, TN
04.2018 - 08.2020
- Demanding and processing claims, obtaining prior authorization, filing appeals, batching EOB's, calling variety of insurance to obtain benefit verification, fixing CPT code errors
- Maintained customer satisfaction and contribute to company success
- Proven ability to establish rapport with clients and exceed sales quotas
- Reliable and driven, with strong time management and prioritization abilities.
- Greeted customers and offered assistance for increased customer satisfaction.
- Increased customer satisfaction by resolving complex issues and providing exceptional service at all times.
- Developed and implemented strategies to increase customer satisfaction and engagement.
- Optimized departmental processes with the implementation of innovative strategies, resulting in improved efficiency and reduced costs.
Case Manager
Zander Insurance - Nashville, TN
10.2017 - 02.2018
- To undertake assessment, monitoring, planning, advocacy and linking of the consumer with rehabilitation and support services.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Achieved positive client outcomes by developing and implementing comprehensive case management plans.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner.
- Coordinated essential services for clients, resulting in improved overall well-being and self-sufficiency.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
Authorization Specialist
TriWest - Nashville, TN
02.2017 - 05.2017
- Interview and assist patients with authorization documents, as appropriate
- Maintain appropriate logs or reports according to professional, state and federal requirements
- Monitor and track patient authorizations, informing supervisor of any expired dates
- Ensure payment for services by verifying benefits with insurance provider
- Obtain, review and input insurance authorization and referrals prior to patient services.
- Demonstrated adaptability with changing insurance requirements, maintaining up-to-date knowledge through continuous education efforts.
- Increased accuracy by diligently reviewing and verifying patient eligibility, coverage, and benefits information.
- Supported clinical staff by providing timely updates on the status of prior authorizations for various services.
Education
High School Diploma -
Nashville Magnet School of The Arts
05.2005
Associate of Science - Business Management
Strayer University
Nashville, TN12-2024
Skills
- Microsoft office
- Claims
- Provider enrollment
- Provider Relations
- Insurance credentialing processes
- Benefits and compensation
- Team Building
- Organizational Development
- Facility support
- Prescription Verification
- Pharmacy Ethics
- Medication Reconciliation
- Customer relations
- Multitasking and organization
- Store operations
Timeline
Store Manager
MAPCO
12.2024 - Current
Store Manager
Dollar General
06.2024 - 02.2025
Pharmacy Specialist
CVS Caremark
08.2021 - 09.2024
Credentialing Specialist
AMN Healthcare
07.2021 - 01.2022
Verification Specialist
Navient Healthcare
02.2021 - 05.2021
Appeal Associate
Cigna - Nashville, TN
04.2018 - 08.2020
Case Manager
Zander Insurance - Nashville, TN
10.2017 - 02.2018
Authorization Specialist
TriWest - Nashville, TN
02.2017 - 05.2017
Customer Service Rep
CVS - Nashville, TN
08.2016 - 04.2021
High School Diploma -
Nashville Magnet School of The Arts
Associate of Science - Business Management
Strayer University
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