Quiara A Boalds
Summary
Dedicated Appeals Specialist with 9 years of experience in healthcare administration. Adept at navigating complex claims and advocating for patient care. Skilled in building collaborative relationships with providers, insurers, and patients to facilitate effective problem-solving. Passionate about transitioning into the mental health sector, aiming to leverage analytical skills and empathetic communication to support individuals on their mental health journeys. Committed to promoting access and quality in mental health services, seeking to make a meaningful impact in patient advocacy and support.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Appeals Specialist, Sr Tech
CVS Caremark
06.2021 - 06.2024
- Prepared 60+ cases daily for medical and administrative review, detailing findings to assist in health plan determinations, while documenting detailed reports for clinical management to expedite resolution of deficiencies.
- Partnered with healthcare supervisors and coordinators to improve mental health treatment appeal processes, fostering collaborative relationships to ensure compliance with regulatory standards and enhance overall patient outcomes.
- Implemented root cause analysis techniques to assess process failures, employing critical thinking to develop and apply preventive measures, thereby increasing compliance with CMS, NCQA, and BMS standards.
- Maintained strong medical terminology knowledge, including familiarity with ICD-10 and CPT codes, to enhance understanding of policies and procedures within the pharmacy department.
- Collaborated with pharmacy supervisors and appeal coordinators to refine pharmacy appeals processes, and utilized continuous quality improvement (CQI) principles to support effective quality improvement plans.
Data Entry/ PCC Pharmacy Technician
Terrapin Pharmacy
08.2019 - 01.2021
- Developed and implemented a new data entry process, resulting in a 25% reduction in errors and a 15% increase in efficiency
- Created detailed reports from data analysis, providing valuable insights to management team and contributing to a 10% increase in revenue
- Oversaw insurance claims processing by optimizing data flow, for case handle time, reducing expenditure by over 15%
- Performed thorough reviews of patient medication records and clinical trial documentation to ensure data accuracy, identifying discrepancies and initiating corrective actions as necessary
- Facilitated effective communication between medical professionals, clients, and project teams through various channels, improving collaboration and information flow
Sr Pharmacy Technician
CVS Pharmacy
02.2017 - 08.2019
- Organized all incoming prescriptions for a high traffic pharmacy with 250-300 customers daily and maintain ensure accuracy during data entry
- Examined medical records regarding needed prescriptions and medication distribution for discrepancies with dosing, drug, and prescriber information
- Entered patient information in database records accurately, expanding patient base by 42% in 6 months
- Trained staff on importance of adherence to clinical protocols and GCP guidelines, improving overall team performance
Administrative Assistant
Donna Lawson
07.2015 - 08.2018
- Conducted in-depth research and performed data analysis of educational programs for enhancing student communication skills, giving a good perspective on accounting methodologies. Expanding budget by 34%.
- Developed and implemented targeted educational programs designed to enhance communication skills for over 100 students from disadvantaged backgrounds, addressing their mental health challenges and fostering an inclusive learning environment.
- Completed administrative tasks such as budget review for initiatives focused on students.
- Conducted research and delivered recommendations to inform decision-making on administrative policies and procedures.
- Managed complex calendars, scheduling appointments, and coordinating meetings with faculty, staff, and students.
Education
Masters of Arts - Counseling for Mental Health and Wellness
New York University Steinhardt
New York, NY05.2026
Bachelors of Science - Psychology
University of Maryland Global Campus
Adelphi, MD05.2024
Associates of Transfer Studies -
Anne Arundel Community College
Arnold, Maryland12.2022
Skills
- Professionalism and ethics
- Pharmacy operations
- Policy analysis
- HIPPA Compliance
- Multicultural competence
- Clinical research
- Patient advocacy
- Health plan benefits
- Patient health education
- HIPAA compliance
- Effective communication
- Medical terminology
- Claims investigation
- Proficient in Google applications and Microsoft Office Suite: Word, Outlook, Powerpoint, and Office
Affiliations
- Certified Pharmacy Technician, Maryland
- Alpha Sigma Lambda Honor Society, 2024
- Behavioral and Social Sciences Student Association, 2023
Certification
- CPhT - Certified Pharmacy Technician
Timeline
Appeals Specialist, Sr Tech
CVS Caremark
06.2021 - 06.2024
Data Entry/ PCC Pharmacy Technician
Terrapin Pharmacy
08.2019 - 01.2021
Sr Pharmacy Technician
CVS Pharmacy
02.2017 - 08.2019
Administrative Assistant
Donna Lawson
07.2015 - 08.2018
Associates of Transfer Studies -
Anne Arundel Community College
- CPhT - Certified Pharmacy Technician
Masters of Arts - Counseling for Mental Health and Wellness
New York University Steinhardt
Bachelors of Science - Psychology
University of Maryland Global Campus
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