Katiera Devine, Healthcare Analyst
Marietta,GA
Summary
Organized and motivated professional eager to apply time management and organizational skills in various environments. Seeking an entry-level opportunity to expand skills while facilitating company growth.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Clinical Review Technician
Roth Staffing - Prime Therapeutics
11.2023 - Current
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations
- Investigated discrepancies between submitted claims and approved and denied authorizations
- Analyzed data from various sources such as claim systems, electronic medical records., for gathering information necessary for processing prior authorization request
- Coded diagnoses and procedures from patient medical records using ICD-10-CM and CPT-4 codes
- Developed systems for tracking and monitoring performance against established standards for turnaround time, accuracy rate.
- Streamlined data entry processes with use of specialized software, such as Microsoft Excel and Word.
Claims Adjuster
E.A. Renfroe & Company Inc
09.2021 - 11.2023
- Investigated and assessed insurance claims, ensuring prompt and accurate resolutions
- Collaborated with policyholders, claimants, and legal representatives to gather information and documentation to ensure coverage based on policy
- Conducted thorough investigations, reviewed data, determined liability and administered payments to settle claims within policy limits
- Applied knowledge of insurance contracts and endorsements, state laws, policy and regulations to settle claims within approved limits
- Utilized claims management software for data entry, analyzing, and reporting
- Addressed customer inquiries and concerns, providing exceptional service throughout claims process.
- Directed claims negotiations within allowable limit of $25,000 and supported successful litigations for advanced issues.
Certified Pharmacy Technician
Walmart Pharmacy
01.2020 - 09.2021
- Accurately and efficiently filled prescription orders under the supervision of licensed pharmacists, ensuring patient safety and adherence to regulatory requirements
- Collaborated with healthcare providers to obtain prescription authorization and clarify any medication-related issues
- Interpreted prescriptions, processed HMO, PPO, Medicare, Medicaid, and all other accepted insurance plans
- Performed medication inventory management, including ordering, receiving, and restocking pharmaceutical supplies
- Utilized pharmacy software systems for prescription processing, insurance claims, and medical data record keeping
- Maintained strict patient confidentiality to adhere to HIPAA regulations and avoid data compromises.
- Coordinated filling and accuracy of more than 350 daily prescriptions in high-volume retail pharmacy environment.
Certified Pharmacy Technician
WellStar Kennestone Hospital
06.2018 - 02.2020
- Assisted in preparation and distribution of medications to hospital patients, including unit-dose packaging and IV admixture
- Maintained pharmacy inventory by checking and analyzing pharmaceutical data and stock to determine inventory levels and removing expiring medications
- Prepared and delivered sterile compounded products in compliance with aseptic techniques and protocols
- Maintained competency and followed departmental, OSHA, USP, and EPA guidelines to handle, prepare, distribute, and dispose of hazardous and non-hazardous medications safely and accurately
- Contributed to quality improvement initiatives by helping to streamline pharmacy processes.
- Coordinated and filling of more than 300 daily prescriptions in high-volume pharmacy environment.
Certified Pharmacy Technician
CVS Pharmacy
09.2016 - 06.2018
- Received, interpreted, and processed prescription orders accurately and efficiently
- Provided exceptional customer service, addressing inquiries and concerns regarding services and products
- Maintained inventory levels by ordering, receiving, stocking, and organizing pharmaceutical supplies
- Processed insurance claims and third-party prescription billing accurately
- Utilized pharmacy software systems for prescription processing, insurance claims, and patient record management while adhering to all federal and state pharmacy laws, regulations, and company policies.
Technical Help Desk Advisor
Concentrix
01.2014 - 01.2016
- Provided technical support to customers via phone or chat by diagnosing and resolving hardware, software, and network-related issues promptly
- Delivered outstanding customer service by actively listening to users, understanding their needs, and addressing their concerns while maintaining professional and patient demeanor in a high-pressure call center environment
- Analyzed and identified root causes of technical problems and recommended solutions
- Assisted in user access management, including password resets and access provisioning
- Ensured compliance with IT security policies and protocols.
- Managed approximately 40 incoming calls, emails and faxes per day from customers.
Education
High School Diploma -
MLK Jr. High School
Lithonia, GASkills
- Professional Coordinating/Collaboration
- Microsoft Office 365
- Attention to Detail
- Analytical Problem Solving
- Verbal and Written Communication
- Work Planning and Prioritization
- Data Quality
- Issue and Resolution Tracking
Certification
Certified by the Pharmacy Technician Certification Board (PTCB)
Timeline
Clinical Review Technician
Roth Staffing - Prime Therapeutics
11.2023 - Current
Claims Adjuster
E.A. Renfroe & Company Inc
09.2021 - 11.2023
Certified Pharmacy Technician
Walmart Pharmacy
01.2020 - 09.2021
Certified Pharmacy Technician
WellStar Kennestone Hospital
06.2018 - 02.2020
Certified Pharmacy Technician
CVS Pharmacy
09.2016 - 06.2018
Technical Help Desk Advisor
Concentrix
01.2014 - 01.2016
High School Diploma -
MLK Jr. High School
Similar Profiles
Jessica RobertsJessica Roberts
Business Solutions Manager at Roth StaffingBusiness Solutions Manager at Roth Staffing
Bernard (bj) Thomas Jr.Bernard (bj) Thomas Jr.
Dock Associate, Order Picker at Roth StaffingDock Associate, Order Picker at Roth Staffing
Joshua EvansJoshua Evans
Administrative Support at Roth StaffingAdministrative Support at Roth Staffing