Kristina Woods
San Antonio,TX
Summary
Analytical problem-solver with the ability to quickly learn new systems. A long history of being a team player and efficient self-starter.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Pharmacy Claims Representative
Humana/CenterWell Specialty Pharmacy
03.2022 - Current
- Worked productively in a fast-moving work environment to process a large volume of pharmacy claims.
- Maintained strong knowledge of basic medical terminology, billing procedures, and ICD-10-CM Codes.
- Made outbound calls to pharmacy benefit managers(PBM) and insurance companies to verify patient insurance benefits and coverage.
- Investigated and resolved claim rejections.
- Assisted with special projects.
Enrollment Representative- Disenrollment
Humana
09.2021 - 03.2022
- Researched, verified, and collected data from multiple databases (CI, CRM, MARx)
- Processed hundreds of disenrollment and cancellation requests per month while maintaining above 99% internal quality standards.
- Applied CMS guidelines to process requests.
- Escalated/ assigned requests to CMS Processing Unit (CPU) or other departments as needed.
- Made outbound calls to members to collect additional information to complete the disenrollment or cancellation process.
Data Entry Clerk
Self-employed
01.2012 - 09.2021
- Completed data entry tasks with accuracy and efficiency.
- Scanned documents and saved in database to keep records of essential organizational information.
- Organized, sorted and checked input data against original documents.
- Verified data files prior to entry to maintain high data accuracy.
- Sorted documents and maintained organized filing process.
Billing Premise Clerk
Comsys
09.2008 - 12.2010
- Executed billing tasks and recorded information in company databases.
- Consistently completed projects on time.
- Verified and audited codes in the billing system.
- Participated in interdepartmental collaboration.
- Prepared billing statements for customers.
- Processed several serviceability requests/work orders daily.
Education
Bachelor of Science - Human Services
Kaplan University
Davenport, IASkills
- Critical Thinking
- Administrative Support
- Researching skills
- Computer proficiency
- Time management skills
- Problem-solving skills
- Organizational skills
- Microsoft 365
Certification
CMAA - Certified Medical Administrative Assistant
Additional Information
United States Navy
United States Army
Timeline
Pharmacy Claims Representative
Humana/CenterWell Specialty Pharmacy
03.2022 - Current
Enrollment Representative- Disenrollment
Humana
09.2021 - 03.2022
Data Entry Clerk
Self-employed
01.2012 - 09.2021
Billing Premise Clerk
Comsys
09.2008 - 12.2010
Bachelor of Science - Human Services
Kaplan University
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