Shaquita Edwards

• Improved customer satisfaction rates by providing timely and empathetic responses to appeals inquiries.
• Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
• Created, composed and maintained appeal response templates.
• Developed comprehensive database of insurance requirements and medication coverage to streamline prior authorization process.
• Verified eligibility and compliance with authorization requirements for service providers.
• Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
• Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.

• Conducted with benefit investigations with insurance companies, physicians, and patients to determine prescription coverage, and eligibility for assistance with payments.
• Accurately entered and maintain data as required for commerical and government plans.
• Learned and maintained in-depth understanding of product information, providing knowledgeable responses to diverse questions.
• Compiled department-specific reports to help senior managers identify trends and improve progress.
• Provided exceptional customer service by addressing patient concerns regarding coverage and out-of-pocket expenses.

• Received fax requests for new prescription fills.
• Enrolled patients in patient assistance programs.
• Made outbound calls to insurance companies to verify preferred and mandated requirements for pharmacy benefits.
• Transferred prescriptions to appropriate pharmacies.
• Educated members about their prescription drug coverage options, empowering them to make informed decisions about their healthcare needs.

• Evaluated operational practices and identified improvement opportunities to develop revisions for systems and procedures.
• Received and responded to customer requests via letters, emails, telephone calls and in-person interactions.
• Used job-related software to draft and finalize written correspondence and documentation.
• Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
• Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
• Corrected, completed and processed claims for multiple payer codes.

Processed online and paper appeal submissions and refund requests.

• Used data entry skills to accurately document and input statements.
• Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.

• Review claims for Medicare Part D
• Process Reimbursement for out of pocket expenses
• Receive written, verbal, and electronic prior authorization
• Complete prior authorization request
• Communicates directly with doctors' offices and pharmacies via telephone, fax, and email

• Verified accuracy and completeness of prescription and refill requests
• Communicated with customers about their order status
• Consistently upheld proper pharmacy and general safety procedures and standards
• Gathered supplies, dispensed medications, and labeled all products appropriately, including cautionary and auxiliary labels