Raven Baker
Jacksonville
Overview
4
4
years of professional experience
Work History
QUALITY ASSURANCE SPECALIST
PRIME THERAPEUTICS (CONTRACTOR)
09.2024 - Current
- Managed tasks independently in an agile environment , meeting deadlines and quality standards.
- Actively participate in daily communication, and team meetings.
- Assessed business requirements to design and configure accurate benefit plans.
- Tested benefit plan coding updates to ensure accuracy and functionality
- Ensure compliance with HIPPA and NCPDP regulations in benefit plan set up and documentation.
PATIENT BILLING AND CLAIMS COORDINATOR
HEALOGICS
04.2023 - 09.2025
- Handle a daily caseload of 20-30 patient inquiries per day via phone, email, or fax
- Successfully resolve denied claims with a 92% claims approval rate by thoroughly reviewing and analyzing claim details
- Utilized EMR system to verify insurance eligibility, patient demographics, and process claims adjustments as needed
- Facilitated the maintenance of accurate patient records by scanning, reviewing, and uploading documents into the EMR system
- Process patient payments for copays, coins, or deductible according to EOB/ERA received from payer
QUALITY ASSURANCE SPECIALIST
PRIME THERAPEUTICS (CONTRACTOR)
05.2022 - 02.2023
- Oversaw a dynamic portfolio of 5-6 complex pharmacy test plans per day
- Performed in-depth analysis of test data to guarantee service level agreements, and benefit plan specification
- Collaborated with testing builders to resolve test errors to ensure plans have a 99% accuracy before being certified
- Meticulously analyzed test data to identify discrepancies in claims adjudication
- Submit ServiceNow request when testing templates need updating
QUALITY ASSURANCE SPECIALIST
PRIME THERAPEUTICS (CONTRACTOR)
08.2021 - 12.2021
- Oversaw a dynamic portfolio of 5-6 complex pharmacy test plans per day
- Performed in-depth analysis of test data to guarantee service level agreements, and benefit plan specification
- Collaborated with testing builders to resolve test errors to ensure plans have a 99% accuracy before being certified
- Meticulously analyzed test data to identify discrepancies in claims adjudication
- Submit ServiceNow request when testing templates need updating
Education
HIGH SCHOOL DIPLOMA -
jean Ribault high school
Skills
- Quality Assurance
- Data Entry
- RXClaim
- PBM
- Excel
- Document Review
- Patient Support
- Problem Solving
- Claims
- EOB
- Verbal & Written Communication
- CPT
- ICD
Timeline
QUALITY ASSURANCE SPECALIST
PRIME THERAPEUTICS (CONTRACTOR)
09.2024 - Current
PATIENT BILLING AND CLAIMS COORDINATOR
HEALOGICS
04.2023 - 09.2025
QUALITY ASSURANCE SPECIALIST
PRIME THERAPEUTICS (CONTRACTOR)
05.2022 - 02.2023
QUALITY ASSURANCE SPECIALIST
PRIME THERAPEUTICS (CONTRACTOR)
08.2021 - 12.2021
HIGH SCHOOL DIPLOMA -
jean Ribault high school
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