Shavonne S Woods
Summary
Knowledgeable and experienced reimbursement specialist, offering demonstrated skills in insurance coverage, patient assistance, prior authorizations, appeals process, billing and reimbursement, and health policy to educate office staff and break through access issues to ultimately help patients. Expertly handles coordination of patient support service programs. Well-versed in policies, procedures and standards.
Overview
18
18
years of professional experience
Work History
Access Reimbursement Specialist
Shields Healthcare Services
Chicago, Illinois
05.2024 - Current
- Educated healthcare providers on prior authorization requirements and insurance formulary changes.
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Negotiated with drug manufacturers and insurance providers to obtain coverage for off-label or non-formulary medications.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Coordinated with pharmacy staff to ensure medications requiring prior authorization are processed correctly.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
Pharmacy Liaison Specialist
Advocate Health Care
Chicago, Illinois
07.2022 - 05.2024
- Identified opportunities for coverage access to address reimbursement barriers.
- Participated in meetings with stakeholders to discuss current trends impacting reimbursement rates.
- Educated healthcare providers on prior authorization requirements and insurance formulary changes.
- Facilitated communication between providers, payers and health plans regarding prior authorization processes.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
Specialty Pharmacy Technician/Patient Care Coordinator
Northwestern Memorial Hospital
03.2018 - 06.2022
- Liaised effectively with patients, doctors and staff members, assessing medical charts and promoting high level of communication and interaction.
- Collaborated with nursing staff to advocate for individual patient needs and insurance coverage.
- Identifying alternate funding/financial assistance program
- Transmitted claims to insurance companies for payment and reconciled EOBs.
- Communicated effectively with doctors and insurance agencies to resolve prescription cost discrepancies.
- Using knowledge of insurance coverage, patient assistance, and health policy to educate office staff and break through access issues to ultimately help patients.
- Utilized knowledge of private payer, medicare, and medicaid structure , systems, and specialty pharmacy and retail pharmacy process.
- Review patient insurance benefit options and validating prior authorization requirements.
CPhT Pharmacy Technician Specialist
Rush University Medical Center, RUMC
01.2017 - 03.2018
- Computed charges for medication or equipment dispensed to hospital patients and entered data into computer.
- Prepared and processed medical insurance claim forms and records.
- Entered prescription information into computer databases.
- Communicated effectively with doctors and insurance agencies to resolve prescription cost discrepancies.
- Established or maintained medications and other patient profiles.
- Transmitted claims to insurance companies for payment and reconciled EOBs.
- Teamed with peers, technicians and pharmacists to prioritize and complete orders.
- Utilize experience in buy and bill (including billing with miscellaneous J-code) formulary benefit investigations, prior authorizations, coding, and appeal processes.
Lead CPhT Pharmacy Technician
Walmart Pharmacy
09.2014 - 12.2017
- Established and updated patient profiles, medications and insurance details.
- Worked with insurance companies to process claims, resolve problems and obtain payments.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Merchandised related products to drive pharmacy department sales.
- Consulted with customers via telephone or in-person to assist with navigating pharmacy systems and completing requests.
- Participated in prescription pharmaceutical and over-the-counter product inventory audits.
- Compiled customer demographic, allergy and medical history background.
- Adhered to regulatory guidelines for workplace safety and customer confidentiality.
Pharmacy Technician Supervisor
MacNeal Hospital
02.2012 - 08.2014
- Maintained communication and transparency with governing boards, department heads and medical staff.
- Maintained records management system to process personnel information and produce reports.
- Kept informed of advances in medicine and computerized diagnostic and treatment equipment.
- Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
- Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
- Recruited, hired and trained new medical and facility staff.
- Planned and implemented programs for health care or medical facilities supporting personnel administration and training.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
Pharmacy Technician Specialist
West Suburban Hospital
05.2010 - 02.2012
- Maintained proper storage and security conditions for drugs.
- Established or maintained medications and other patient profiles.
- Checked medications for content, accuracy and completeness of drug packaging and labeling.
- Received and stored incoming supplies and informed supervisors of stock needs and shortages.
- Prepacked bulk medicines, filled bottles with prescribed medications and typed and affixed labels.
- Transferred medication from vials to sterile, disposable syringes using aseptic techniques.
- Mixed pharmaceutical preparations according to written prescriptions.
- Cleaned and maintained equipment or work areas according to prescribed methods.
Lead Certified Pharmacy Technician
Walgreens Specialty Pharmacy
05.2008 - 04.2010
- Maintains a focus on accuracy, efficacy, and delivered courteous service at all times.
- Work with healthcare professionals to ensure that patients have access to the medication they need.
- Deep understanding of Medical and Pharmacy benefits policies.
- Answered telephones to respond to questions or requests.
- Established or maintained medications and other patient profiles.
- Using knowledge of insurance coverage, patient assistance, and health policy tp educate office staff and break through access issues to ultimately help patients.
- Entered prescription information into computer databases.
- Prepared and processed medical insurance claim forms and records.
Pharmacy Technician
Osco Drug
06.2007 - 05.2008
- Leveraged database to confirm validity of prescriptions, patient data and drug side effects.
- Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.
- Maintained pharmacological practices by checking drug inventory, stocking medications and monitoring supplies.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Improved inventory management procedures to reduce overhead, backorders and overstock.
- Interpreted and processed medication orders under supervision of pharmacist.
- Teamed with peers, technicians and pharmacists to prioritize and complete orders.
- Prepared prescription transfers to other pharmacies.
Education
Biological Sciences
Moraine Valley Community College
Palos Hills, ILMedicinal and Pharmaceutical Chemistry
Eastern Illinois University
Charleston, ILSkills
- Prior Authorization Certified Specialist
- Billing and Reimbursement Specialist
- Buy and Bill
- Insurance Billing/Coding
- Quality Assurance
- Public Speaking/Presentation
- Microsoft Office
- Microsoft Excel
- Medication therapy management (MTM)
- Organized and Detail-Oriented
- Patient Reimbursements
- Medical Terminology Expertise
Timeline
Access Reimbursement Specialist
Shields Healthcare Services
05.2024 - Current
Pharmacy Liaison Specialist
Advocate Health Care
07.2022 - 05.2024
Specialty Pharmacy Technician/Patient Care Coordinator
Northwestern Memorial Hospital
03.2018 - 06.2022
CPhT Pharmacy Technician Specialist
Rush University Medical Center, RUMC
01.2017 - 03.2018
Lead CPhT Pharmacy Technician
Walmart Pharmacy
09.2014 - 12.2017
Pharmacy Technician Supervisor
MacNeal Hospital
02.2012 - 08.2014
Pharmacy Technician Specialist
West Suburban Hospital
05.2010 - 02.2012
Lead Certified Pharmacy Technician
Walgreens Specialty Pharmacy
05.2008 - 04.2010
Pharmacy Technician
Osco Drug
06.2007 - 05.2008
Biological Sciences
Moraine Valley Community College
Medicinal and Pharmaceutical Chemistry
Eastern Illinois University