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
Similar Profiles
Brionna WilsonBrionna Wilson
Outbound Contact Representative 2 at Humana(CenterWell Specialty Pharmacy)Outbound Contact Representative 2 at Humana(CenterWell Specialty Pharmacy)
REBECCA SALDANAREBECCA SALDANA
Supervisor at CenterWell Pharmacy, Formerly Humana PharmacySupervisor at CenterWell Pharmacy, Formerly Humana Pharmacy
Tanisha LeeTanisha Lee
Customer Experience Associate II at Centerwell Pharmacy (Humana)Customer Experience Associate II at Centerwell Pharmacy (Humana)