Melissa Harrison
Apollo,PA
Summary
To further my experience while utilizing my skills, creativity, and positive attitude to impact the company’s growth. Experienced with insurance verification processes, ensuring accurate and timely handling of patient information. Utilizes strong analytical skills to identify and resolve discrepancies, maintaining seamless operational flow. Knowledge of industry regulations and best practices, contributing to overall efficiency and reduced claim rejections.
Overview
21
21
years of professional experience
Work History
Advanced Specialty Care Representative
CVS Caremark Specialty Pharmacy
Chicago, IL
03.2021 - Current
- Managed over 150 patient inquiries weekly with empathy and efficiency to ensure positive experiences.
- Coordinated medication fulfillment processes, optimizing workflow for timely deliveries.
- Pharmacy Tech – process and download medications and orders
- Provided education on specialty medications, enhancing patient understanding and adherence.
- Collaborated with healthcare providers to resolve prescription issues promptly.
- Implemented process improvements that streamlined operations and reduced errors.
- Led initiatives to enhance customer service protocols, improving overall satisfaction ratings.
- Trained new staff on systems and best practices, fostering a knowledgeable team environment.
- Researched issues and took appropriate action to resolve issues within turnaround time requirements and quality standards.
- Verified patient insurance eligibility and entered patient information into system.
- Provided excellent customer service to patients and medical staff.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Contributed to team success by consistently achieving performance goals and adhering to established service standards within the role of Care Representative.
- Utilized strong organizational skills to manage multiple patient caseloads efficiently while maintaining high levels of service quality.
- Resolved billing issues promptly, leading to a higher level of customer satisfaction.
- Maintained strict adherence to HIPAA regulations when handling sensitive patient data, ensuring confidentiality and privacy protection at all times.
- Efficiently managed time-sensitive tasks such as medication refills or filling out necessary forms for completion.
- Expedited claim resolution by accurately documenting insurance information and processing paperwork in a timely manner.
FREELANCE
Freelance
Pittsburgh, PA
01.2005 - Current
- Market and design invitations and response cards, business cards, menus, advertisements, t-shirt designs, and magazine layouts.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
INSURANCE VERIFICATION REPRESENTATIVE II
CVS Caremark Specialty Pharmacy
Monroeville, PA
01.2013 - 03.2022
- Lead IVIG Infusion Department
- Verified insurance eligibility and benefits for specialty medications for over 100 specialty clients weekly.
- Processed prior authorization requests efficiently to ensure timely medication access.
- Communicated effectively with healthcare providers to resolve billing discrepancies.
- Train representatives who join the team and provide any assistance that may be needed
- Make executive decisions, as needed, especially working all escalations that arise
- Guarantee life sustaining medication and supplies arrive to the patient as needed, either biweekly or monthly
- Coordinate medications, authorizations, nursing, and supplies with other companies/locations to ensure orders/shipments are completed and delivered on time for our patients
- Ensure all orders, filled and shipped, follow CVS Caremark Specialty Pharmacy policies and procedures
- Participate in weekly conference calls and meetings to ensure the department runs smoothly and efficiently, also to stay up-to-date with current company policies and procedures
- Maintain Excel spreadsheet to guarantee patients’ new orders, refills, and authorizations are up-to-date and on time
- Pharmacy Tech – process and download medications and orders
- Verify and ensure coverage for patients’ medications monthly
- Obtain initial and renewal prior authorizations
- Obtain initial and renewal prescriptions
- Ensure Nursing for patients’ monthly infusions
- Provide excellent Customer Service to patients, health care professionals, and insurance providers
HEALTH CARE CONCIERGE/CORRESPONDENCE
UPMC Health Plan
Pittsburgh, PA
01.2011 - 01.2013
- Medicare/SNP Member Services Representative
- Medstar Member Services Representative
- Coordinated patient services to enhance satisfaction and streamline access to care resources.
- Health Plan Correspondence
- Responsible for TLC/CMS calls
- TLC TTY Reporting
- Update Personal Representative forms and Power of Attorney forms
- Nurse Triage Line
- Web Messaging
- Enrollment Verification calls
- Reported Red Alert calls
ADMISSIONS REPRESENTATIVE
EDMC Art Institute of Pittsburgh Online Division
Pittsburgh, PA
01.2011 - 01.2011
- Facilitated over 10 student inquiries and guided prospective students through admissions process weekly
- Provided detailed information on program offerings and enrollment procedures
MANAGER/BARTENDER/GRAPHIC DESIGNER
Carl’s Tavern
Pittsburgh, PA
01.2007 - 01.2011
- Designed menus, t-shirts, and advertisements.
- Shift Manager/Bartender
- Oversaw daily operations, ensuring exceptional customer service and efficient workflow.
- Trained and mentored staff to enhance team performance and operational efficiency.
FRONT OFFICE MANAGER/GRAPHIC DESIGNER
Auto Bathouse
Monroeville, PA
01.2005 - 01.2011
- Designed advertisements
- Scheduled employees
- Controlled payroll
- Customer satisfaction
Education
Bachelor Degree - Fine Arts
POINT PARK UNIVERSITY
Pittsburgh, PA01-2009
Associate Degree - Specialized Technology
INTERNATIONAL ACADEMY OF DESIGN AND TECHNOLOGY
Pittsburgh, PA01-2004
Diploma -
GATEWAY SENIOR HIGH SCHOOL
Monroeville, PA01-2002
Skills
- Call center experience
- Email communication
- Data entry
- Insurance verification
- Insurance billing
- Eligibility determination
- Policy understanding
- Phone and email etiquette
- HIPAA compliance
- Problem-solving
- Team collaboration
- Medical billing
- Insurance authorizations
Timeline
Advanced Specialty Care Representative
CVS Caremark Specialty Pharmacy
03.2021 - Current
INSURANCE VERIFICATION REPRESENTATIVE II
CVS Caremark Specialty Pharmacy
01.2013 - 03.2022
HEALTH CARE CONCIERGE/CORRESPONDENCE
UPMC Health Plan
01.2011 - 01.2013
ADMISSIONS REPRESENTATIVE
EDMC Art Institute of Pittsburgh Online Division
01.2011 - 01.2011
MANAGER/BARTENDER/GRAPHIC DESIGNER
Carl’s Tavern
01.2007 - 01.2011
FREELANCE
Freelance
01.2005 - Current
FRONT OFFICE MANAGER/GRAPHIC DESIGNER
Auto Bathouse
01.2005 - 01.2011
Bachelor Degree - Fine Arts
POINT PARK UNIVERSITY
Associate Degree - Specialized Technology
INTERNATIONAL ACADEMY OF DESIGN AND TECHNOLOGY
Diploma -
GATEWAY SENIOR HIGH SCHOOL
PERSONAL SKILLS
I am creative, reliable, responsible, out-going, hard working, energetic, and have a positive attitude.