Sarah Kosmos
Cleveland,OH
Summary
Results-driven leader with positive attitude and passion for providing high-quality advice and guidance to clients. Proven ability to identify customer needs, resolve conflicts and build strong relationships. Possesses excellent problem-solving, communication and interpersonal skills.
Overview
13
13
years of professional experience
Work History
Senior Prescription Advisor
Transparent Risk Strategies
09.2022 - Current
- Maintained patient profile and case notes using MedData.
- Developed training materials for new staff on benefits processes and system navigation best practices.
- Collaborated with cross-functional teams to enhance risk management frameworks and methodologies.
- Promoted a positive work environment through collaborative teamwork and clear communication among colleagues.
- Liaised between patients, healthcare providers, insurers, pharmacists, creating a seamless experience for all parties involved in the prescription process.
- Demonstrated a strong commitment to customer satisfaction, going above and beyond to ensure the highest level of care for each patient served.
- Participated in ongoing professional development opportunities to stay current on industry trends and regulatory changes affecting pharmacy operations.
- Assisted in training new staff on customer service protocols and operational workflows.
- Coordinated with billing departments to clarify account discrepancies for improved resolution rates.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
- Developed strong relationships with clients by providing empathetic support and understanding during challenging health situations.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Facilitated smooth communication between patients, insurance companies, and medical staff for seamless coordination of care.
- Promoted a positive work environment through active participation in team meetings and contributing ideas for organizational success.
- Collaborated with team members to identify areas for improvement in customer service processes, implementing changes as needed.
- Educated customers about billing, payment processing and support policies and procedures.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Increased efficiency and performance by monitoring team member productivity and providing feedback.
Medical Claims Examiner
UFCW Local 880 Health and Welfare Office
01.2020 - 07.2022
- Reviewed and adjudicated medical claims for accuracy and compliance with policies.
- Analyzed complex claims to determine eligibility and appropriate benefit coverage.
- Collaborated with healthcare providers to resolve discrepancies in claim submissions.
- Conducted audits of processed claims to identify trends and areas for improvement.
- Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
- Improved interdepartmental communication by fostering a collaborative environment and sharing vital information regarding complex cases.
- Collaborated with healthcare providers to obtain necessary medical records, ensuring timely and accurate claim adjudication.
- Reduced errors in claim submissions by meticulously reviewing patient information and verifying insurance eligibility.
- Supported team members during periods of high workload, providing guidance on challenging cases or offering assistance when needed.
- Researched and resolved complex medical claims issues to support timely processing.
- Reviewed provider coding information to report services and verify correctness.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Maintained claims data in Innovative Software Solutions systems.
Prescription Benefit Specialist
J.P. Farley
05.2017 - 11.2018
- Analyzed prescription benefit claims to ensure compliance with policies and regulations.
- Facilitated communication between patients, providers, and pharmacies to resolve benefit inquiries.
- Educated clients on formulary updates and medication coverage options to optimize benefits utilization.
- Collaborated with cross-functional teams to address complex prescription-related issues proactively.
- Reviewed and analyzed appeal cases to determine eligibility for benefits.
- Collaborated with cross-functional teams to gather necessary documentation and evidence to support the appeals process.
Second Shift Coordinator
Hospice of the Western Reserve
04.2013 - 09.2017
- Coordinated daily operations to ensure seamless patient care and support services.
- Trained and mentored staff on best practices in hospice care delivery.
- Implemented process improvements to enhance operational efficiency and patient satisfaction.
- Facilitated communication between families, staff, and healthcare providers for effective care coordination.
- Successfully managed conflicts among staff members, resulting in improved morale and reduced workplace tension.
- Coordinated cross-departmental collaboration for seamless operations during shifts.
- Monitored inventory levels, ensuring adequate supplies were available for uninterrupted operations during shifts.
- Assisted management in identifying areas of improvement within the facility, leading to increased productivity and overall success.
- Ensured compliance with all applicable local, state, federal regulations governing workplace safety during assigned shifts.
- Interpreted management directives, performed daily assignments, and completed special projects.
- Resolved customer complaints and issues and offered thoughtful solutions to maintain customer satisfaction.
- Managed inventory and ordered supplies to keep location well stocked with necessary supplies.
- Planned and executed promotions and special events in close collaboration with management.
Education
Associate of Arts -
Lorain County Community College
Elyria, OH05-2016
Associate of Science - Applied Psychology
Lorain County Community College
Elyria, OH05-2016
Skills
- Analytical thinking
- Time management
- Critical thinking
- Written communication
- Relationship building
- Training and mentoring
- Problem-solving
- Client relationship management
- Empathy and understanding
- Industry knowledge
- Excellent communication
- Organizational skills
- Attention to detail
- Staff supervision
Timeline
Senior Prescription Advisor
Transparent Risk Strategies
09.2022 - Current
Medical Claims Examiner
UFCW Local 880 Health and Welfare Office
01.2020 - 07.2022
Prescription Benefit Specialist
J.P. Farley
05.2017 - 11.2018
Second Shift Coordinator
Hospice of the Western Reserve
04.2013 - 09.2017
Associate of Arts -
Lorain County Community College
Associate of Science - Applied Psychology
Lorain County Community College