Open To Work
Kristina McPhail
All Care Plus Pharmacy
Philadelphia,PA
Work Preference
Job Search Status:
Open to work
Desired start date:
Open to discussion
Desired Job Title
Care ManagerClaims Support RepresentativeCustomer Service RepresentativePrecertification Specialist/Scheduler
Work Type
Part TimeContract WorkGig WorkSeasonal Work
Location Preference
On-SiteRemoteHybrid
Location:
Philadelphia, PA
Open to relocation:
Yes
Important To Me
Work-life balanceHealthcare benefits4-day work week
15
years of professional experience
A Business Support professional with experience in the Healthcare, Administrative and Education industries. Capable of utilizing multiple software including Microsoft Office suite and several medical databases. Possessing outstanding communication skills to work with outside vendors and employees at all levels of an organization. I am a detail oriented, highly organized team player with outstanding customer service skills. Seeking a position to contribute my experiences to the success of an organization rather it’s working remotely or in office.
Healthcare professional with track record of effective patient care management and team collaboration. Expertise in developing and implementing individualized care plans that meet diverse patient needs. Known for strong focus on achieving results and seamlessly adapting to changing healthcare environments. Skilled in communication, conflict resolution, and resource management.
Work History
Care Manager
4 Years 5 Months- Collaborated with clinical pharmacists to conduct insurance coverage verification and complete prior authorizations, expediting reimbursement issue resolution and proper client support.
- Managed inbound inquiries to assist patients through copay assistance program enrollment and medication expense discussions while supporting healthcare professionals and specialty pharmacies.
- Analyzed data to identify trends and develop workflow optimization proposals to exceed productivity goals.
- Participated in educational programs and training initiatives to ensure up-to-date knowledge and skills.
- Enhanced quality benchmarks and procedural standards in a remote home office by managing inbound and outbound communications, including calls, emails, and online chats.
Claims Support Representative
1 Year- To assist non routine and overseas beneficiaries on the TRICARE Benefit, claims submission processes and options, resolving and escalating claims issues when required.
- To assist beneficiaries and providers with claims inquiries and help resolve problem cases one on one or by referral to dedicated in country or regional claim resources.
- Maintains confidentiality of all beneficiary information.
- Understand and carry out all policies and procedures pertaining to a Claims Customer Support Representative.
- Answer all incoming calls using the telephone etiquette protocol. Maintain all documentation in accordance with company policies and procedures. Respond to in-bound inquiries promptly and ensure complete resolution.
- Make outbound calls to follow up with beneficiaries and providers on claim queries, when appropriate.
- Resolve claim issues on behalf of providers and beneficiaries, working with Intl. SOS teams and WPS to ensure timely and accurate resolution.
- To work with International SOS teams and designated government points of contacts to ensure TRICARE claims processes and benefits rules are understood and communicated accurately to beneficiaries
- Actively promote electronic submission and payment solutions and other self-servicing products.
- Maintain specific quality and quantity standards.
- Adhere to company policies and procedures at all times, regardless of shift being worked.
- Assist with the training of new staff by mentoring them during their training program, when asked.
- Comply within established service recovery protocol.
- Attends and participated in International SOS staff meetings and educational offerings.
Customer Service Representative
- Assisted Patients with finding doctors affiliated with Penn Medicine
- Assisted Patients by transferring to the doctors’ office and staff for refill issues, scheduling appointments, and any other clinical issues.
- Assisted Patients with signing up for Penn Medicine workshops and classes.
Precertification Specialist/Scheduler
2 Years- Utilize E-Clinical Medical System to schedule and reschedule patients to come in to office for pain management services in the office or in the ambulatory surgery center.
- Utilized Availity and Navinet to determine benefits and authorize approval for pain management procedures.
- Made sure paperwork and services were completed in a timely manner and sent to the office and surgery center.
- Notified patients of copayments before coming into the office.
- Made sure referrals and authorizations were in the system before a patient came to our facilities.
Customer Service Representative
4 Years- Ensure that all customers’ questions were answered concerning their health insurance policies with a primary focus on making sure they were informed about their claims, benefits, eligibility, enrollment, and website support.
- Handle all members’ complaints and grievances and appeals in a timely manner and made sure I was in consistent communication with members’ all the time with frequent updates.
- Went above and beyond to resolve questions complaints in a timely manner reached out to doctors and providers to make sure members would not have issues with services needed.
- Researched providers that were in network and accepted insurance for members that were all over the United States.
- Communicated with Federal Marketplace representatives providing necessary information for potential insurance members
- Worked directly with supervisors for expedited calls, providing research support to resolve escalated issues
- Documented all communications in multiple medical databases including SLIQ, INSINQ and EOE
Education
Bachelor of Computer Science
Associate of Business Administration
Skills
Data Management
Empathy & Sympathy Communication
Customer Communication
Relationship-Building
Solution Development
Inquiry Management
Account Recovery
Account Management
Cash Flow Management
Data Entry
TECHNICAL SKILLS
- Microsoft Office (Word, Excel, PowerPoint, Outlook, Access, Publisher)
- Salesforce
- CRM
- SLIQ/INSINQ
- Epic
- Availity
- IExchange
- Navinet
- Google Workspace (Docs, Sheets, Slides)
- Front Runner/PRM
Timeline
Care Manager
All Care Plus Pharmacy
01.2022 - CurrentRead More
Claims Support Representative
International SOS/TRICARE OVERSEAS
01.2021 - 01.2022Read More
Customer Service Representative
Apple One Employment Agency/Penn Medicine
01.2020 - 01.2020Read More
Precertification Specialist/Scheduler
Main Line Spine
01.2018 - 01.2020Read More
Pyramid Health Care
01.2016 - 01.2016Read More
Customer Service Representative
Independence Blue Cross
01.2011 - 01.2015Read More
CITE Business School
Associate of Business Administration
Read More
DeVry University
Bachelor of Computer Science
Read More