Summary
Overview
Work History
Education
Skills
Timeline
Generic

Shawna Huffman

Grove City

Summary

I have 17 years of experience working in the Healthcare/Pharmacy industry. Ranging from Customer Service, Eligibility, Test Claims and Accounts Receivable and more. Looking for a new adventure. Enjoys learning new things and can adapt to change. Eager to expand my knowledge and advance my skills.

Overview

19
19
years of professional experience

Work History

Patient Service Representative

Quantum Health
10.2023 - Current
  • Job functions included but not limited to
  • Taking inbound calls
  • Reviewing and going over insurance benefits for member and providers
  • Initiating Prior Authorizations
  • Contacting PBM to resolve pharmacy issues.
  • Contacting Dr’s office or hospitals to help resolve billing issues or insurance issues.
  • Sending claims to be reprocessed
  • Researching claims
  • Sending claims to be reprocessed
  • Protecting a members personal health information.
  • Paying close attention to details and correcting if needed
  • Typing on a computer all day to enter information as well as calls details.

Technical Training Senior Analyst

Cigna
06.2022 - 04.2023
  • Worked in the Specialty Learning & Development Team for Accredo specialty. Was let go due to staff reduction.
  • Job functions included but not limited to training New Hire reps for the Accredo specialty pharmacy.
  • Up trained reps who require additional assistance.
  • Helped prepare material for training classes as well as update material when required
  • Trained reps for the required CARE class

Patient Access Eligibility Representative II

Accredo Specialty (Cigna)
12.2019 - 06.2022
  • Worked in the Clearance Department for Accredo Specialty.
  • Job functions included but are not limited to following HIPPA and protecting IHI.
  • Verified pharmacy and medical insurance information for processing orders.
  • Contacted Clients, patients and Dr’s office when needed.
  • Obtaining Prior Authorization when needed
  • Running Test claims to determine copay or rejections.
  • Followed SOPs for correct processing. Verified Secondary insurance and Copay assistance for payment.
  • Paying attention to details and verifying all information for the patient and insurance is correct for processing.
  • Learned Ship Clearance
  • TAP trained.
  • Facilitated New Hire reps for CareCentral only users.
  • Was a SME (Subject Matter Expect)

Eligibility Representative

Express Scripts (Cigna)
02.2006 - 12.2019
  • Worked in Express Scripts frontend (Cigna)
  • Job functions included but not limited to following HIPPA and protecting IHI.
  • Followed SOPs for correct processing.
  • Verified patients account information for processing under PBM.
  • Contacting patients for address verification
  • Paying close attention to details to prevent issues with accounts.
  • Spotting and reporting MED Events and performing the cleanup.
  • Updated and created new processes to help customer satisfaction and process improvements.
  • Resolved escalated issues which sometimes would include contacting clients.
  • Provided new hire training on site as well as traveled out of state to other locations.
  • Researching to determine why order is not processing and fix issues.
  • Learned Research and Correspondence
  • Validating address issues
  • Learned Order Entry
  • Reviewing incoming scripts and entering in system for processing.

Education

High School Diploma -

Westland High School
06.2002

Skills

  • Professional expertise
  • Excellent accuracy and attention to details skills
  • Works independently
  • Working off 2 monitors
  • Knowledge of eSD, Blue Zone, Rx home, TMW, Verint and Webex
  • Knowledge of Microsoft Word, Excel, PowerPoint, Outlook
  • Multitask
  • Great verbal and written communication skills
  • Ability to learn new systems and skills
  • Ability to adapt to change
  • Ability to work and collaborate with others
  • Running test claims
  • Great problem-solving skills
  • Excellent customer service skills
  • Excellent typing/keyboard skills
  • Prior Authorization knowledge
  • Communication skills
  • Training and Development
  • Proficient in typing

Timeline

Patient Service Representative

Quantum Health
10.2023 - Current

Technical Training Senior Analyst

Cigna
06.2022 - 04.2023

Patient Access Eligibility Representative II

Accredo Specialty (Cigna)
12.2019 - 06.2022

Eligibility Representative

Express Scripts (Cigna)
02.2006 - 12.2019

High School Diploma -

Westland High School

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Shawna Huffman