Kristina Hale
Bioplus Pharmacy
Indianapolis,IN
11
years of professional experience
Seeking a role within a forward-thinking organization to leverage academic knowledge and practical experience for driving operational efficiency and elevating company standing. Eager to contribute expertise in an innovative environment, making a meaningful impact on success. Committed to achieving strategic goals and fostering a culture of excellence. Passionate about delivering high-quality work that aligns with company vision and mission.
Work History
Prior Auth Coordinator
5 Months- Analyzed rejected pharmacy claims to identify rejection codes.
- Handled claims following authorization adjustments.
- Processed pharmacy authorizations to assist with timely delivery of client’s medications
- Collaborated with insurance providers to address rejection codes.
MMI Referral Intake Supervisor
2 Years 8 Months- Supervised team of 12 coordinators managing clinical medical authorization tasks.
- Oversaw production workflows and assigned responsibilities to team members.
- Led monthly sessions to discuss team progress.
- Enhanced team performance by conducting individualized feedback discussions.
- Streamlined processes to enhance team efficiency.
- Partnered with leaders from multiple departments to resolve escalations and implement improvements.
MMI Interim Supervisor
1 Year- Stepped into role of Interim Supervisor.
- Provided assistance to MMI intake teams through direct collaboration with management and peer supervisors.
- Partnered with different units to tackle authorization challenges.
- Manage team activities each day, compile department reports, and design production schedules to support staff in meeting task requirements.
Referral Specialist Lead
5 Years 6 Months- Began role as Referral Specialist, assisting in monitoring utilization of medical services to ensure cost-effective use of resources through processing prior authorizations.
- Initiated authorization requests for outpatient and inpatient services per prior authorization list.
- Answer phone queues and process faxes through provider discussions.
- Advanced to RS II, taking on responsibilities such as training new hires.
- Contributed to team discussions, earning advancement to RS Team Lead.
- Facilitated group meetings to ensure full engagement from all team members.
- Monitor the phone queues daily to ensure service levels are being met, handle escalated calls, and assist with the phone queues when short staffed.
- Collaborated across departments to develop unified solutions for authorization and training issues.
Customer Service Representative
3 Months- Resolved member issues efficiently by ensuring one-call resolution for health insurance queries.
- Offered different strategies to maintain member contentment.
- Offered assistance to members requiring access to company websites.
Prior Authorization Data Entry Specialist
7 Months- Utilized case fax manager to handle various authorization requests.
- Employed AIM to process patient details and acquire authorization numbers.
- Transferred AIM requests to the fax manager system to ensure accurate departmental submission.
Education
Associate of Applied Science - medical billing & coding
Skills
Proficient in Microsoft Office and other Windows based programs
Ability to self-manage & self- motivated
Analytical problem solver
Excellent team player
Ability to type 45+WPM
Business Administration Certificate – Job Corp.
Medical terminology Knowledge/ICD-10 and CPT coding experience.
Multitasking and organization
Data entry
Customer service
Decision-making
Work Planning and Prioritization
Relationship building
Project coordination
Timeline
Prior Auth Coordinator
Bioplus Pharmacy
03.2024 - 08.2024Read More
MMI Referral Intake Supervisor
MHS
04.2021 - 12.2023Read More
MMI Interim Supervisor
MHS
10.2020 - 10.2021Read More
Referral Specialist Lead
MHS
04.2015 - 10.2020Read More
Customer Service Representative
Healthcare Support/MHS
12.2014 - 03.2015Read More
Prior Authorization Data Entry Specialist
CFA Staffing/Advantage Healthcare
10.2013 - 05.2014Read More
Medtech College
Associate of Applied Science from medical billing & coding
Read More