Summary
Overview
Work History
Education
Skills
Certification
Work Availability
Work Preference
Languages
Quote
Timeline
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Reanna Ashcraft

North Richland Hills,Texas

Summary

Professional with solid experience in end to end claims management, ready to drive effective solutions and results. Strong medical analytical skills, adept at problem-solving, and thorough in documentation. Adept at maintaining high regulatory standards, and providing expert guidance on prior authorizations, claim disputes, and reimbursement processes.

Overview

10
10
years of professional experience

Work History

Medicare B Representative

PharMerica
07.2024 - Current
  • Prepared reports for workload and performed quality assurance.
  • Collaborated with healthcare providers for timely resolution of discrepancies, ensuring accurate financial reimbursement.
  • Handled complex claim issues, effectively communicating with patients, providers, and insurance companies to ensure resolution.
  • Verified long term care patient insurance coverage and benefits for medical and prescriptions claims.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.

Certified Pharmacy Technician - IBT Specialist

UnitedHealth Group, UHG
11.2021 - 07.2024
  • Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
  • Managed insurance billing and claims processing, streamlining the reimbursement process for patients and pharmacy.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Collaborated with healthcare providers to obtain crucial information, leading to more accurate and faster decision-making on claims.

Mail Operations Pharmacy Technician 2

Humana Pharmacy
05.2020 - 10.2021
  • Streamlined prescription processing with accurate data entry and verification of patient information.
  • Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
  • Expedited insurance claim resolutions by liaising with healthcare providers and insurance companies on patients'' behalf.
  • Streamlined case review processes for increased efficiency and accuracy in decisionmaking.
  • Displayed strong analytical skills when evaluating evidence and information, leading to well-reasoned judgments in case determinations.

UM Administrative Coordinator

Humana Pharmacy
09.2019 - 05.2020
  • Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
  • Reduced errors in documentation by meticulously reviewing medical records and verifying information accuracy.
  • Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
  • Facilitated better communication between departments through proactive engagement with other teams involved in the prior authorization process.
  • Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.

Inbound Contact Representative 1

Humana Pharmacy
11.2018 - 09.2019
  • Demonstrated empathy when addressing sensitive situations, creating trust between the company and clientele.
  • Proactively identified potential areas of improvement within the contact center''s operations, offering suggestions and helping to implement changes that led to enhanced customer experiences.
  • Improved customer satisfaction by resolving issues efficiently and professionally.
  • Managed time efficiently in order to complete all tasks within deadlines.
  • Assisted with day-to-day operations, working efficiently and productively with all team members.

Clinical Patient Coordinator

McKesson Specialty Pharmacy
08.2018 - 11.2018
  • Acted as main point of contact for patients, doctors, and hospital staff by closely reviewing medical charts and maintaining high levels of communication.
  • Maintained up-to-date knowledge on insurance policies, medical terminology, and clinic protocols in order to provide accurate information and assistance to patients.
  • Assisted in the development of a robust training program aimed at enhancing staff knowledge about industry trends and emerging strategies in dispute resolution practices.
  • Coded and abstracted medical records according to ICD-10-CM and CPT coding guidelines.
  • Catalogued patient data in clinical databases and registries according to regulatory practices.

Education

BBA - Business Administration

Western Governors University
Salt Lake City, UT
06-2026

Associate of Arts - Art

Tarrant County College
Fort Worth, TX
06-2016

Skills

  • Claims investigation
  • Financial acumen
  • Claims analysis
  • Customer service
  • Problem-solving abilities
  • Organizing and prioritizing work
  • Microsoft office
  • Comprehension of medical terminology
  • Data management
  • Critical Thinking
  • Insurance Verification
  • Long Term Claims Assessments
  • Benefits explanation

Certification

  • Certified Pharmacy Technician, Texas State Board of Pharmacy - 2014 - Current.
  • Certified Pharmacy Technician, Pharmacy Technician Certification Board - 2014 - Current.

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference

Work Type

Full Time

Work Location

Remote

Important To Me

Healthcare benefitsWork from home optionCareer advancementFlexible work hours

Languages

English
Native or Bilingual

Quote

Where you stumble and fall, there you discover the gold.
Joseph Campbell

Timeline

Medicare B Representative

PharMerica
07.2024 - Current

Certified Pharmacy Technician - IBT Specialist

UnitedHealth Group, UHG
11.2021 - 07.2024

Mail Operations Pharmacy Technician 2

Humana Pharmacy
05.2020 - 10.2021

UM Administrative Coordinator

Humana Pharmacy
09.2019 - 05.2020

Inbound Contact Representative 1

Humana Pharmacy
11.2018 - 09.2019

Clinical Patient Coordinator

McKesson Specialty Pharmacy
08.2018 - 11.2018

BBA - Business Administration

Western Governors University

Associate of Arts - Art

Tarrant County College

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