Takeidra Alexander
Arlington,Tx
Summary
Seeking a Reimbursement Case Manager role, offering 8 years of experience in specialty pharmacy and medical insurance. Skilled in coverage verification, reimbursement processes, and maintaining compliance within the Dallas-Fort Worth healthcare sector. Offering passion for helping others, combined with strong organizational and communication skills, and eager to learn and grow in supportive environment. Brings dedicated approach to understanding and addressing client needs, with ability to quickly assimilate new information and procedures. Ready to use and develop problem-solving and interpersonal skills in Reimbursement Case Manager role.
Overview
9
9
years of professional experience
Work History
QA Specialist
CareMetx (CornerStone Staffing)
12.2024 - Current
- Ensured compliance with industry standards and regulations through diligent adherence to established QA procedures and guidelines.
- Facilitated effective communication between QA, development, and management teams through regular status updates on ongoing projects, including progress reports and issue tracking metrics.
- Reviewed production processes and identified potential quality issues.
- Increased overall testing accuracy by creating detailed test scripts based on functional and technical requirements documentation.
Coverage Determination Representative
CVS Health
10.2023 - 09.2024
- Company Overview: Ask Consulting
- Assessed and compiled authorization information to ensure accurate processing of requests
- Completed and submitted relevant forms in compliance with healthcare regulations
- Conducted thorough follow-ups with physician offices and patients to maintain communication and service continuity
- Ask Consulting
Case Manager
RemX-McKesson
07.2022 - 05.2023
- Verified patient insurance and coverage for oncology medications, ensuring accuracy and adherence to timelines
- Collaborated with healthcare professionals and insurance payers to secure coverage approvals for cancer treatment drugs
- Communicated the benefits and effectiveness of pharmaceutical products to influence payer policies and support patient access
Customer Service Representative
CVS Health
10.2020 - 04.2022
- Managed the processing of prior authorizations and appeals for specialty medications, ensuring compliance with healthcare regulations and policies
- Coordinated with doctors' offices, insurance firms, and pharmacies through outbound calls to gather necessary information for submissions
- Conducted diligent follow-ups on authorization requests and appeals, providing timely updates on approval or denial statuses to medical practitioners
Prior Authorization Specialist
Senderra RX Pharmacy
04.2017 - 10.2018
- Managed the complete process of prior authorizations and appeals for specialty medications, ensuring timely follow-up and accurate reporting of approval or denial statuses to healthcare providers
- Maintained proficiency in verification and precertification processes for patient accounts at various stages, including preadmission, admission, and discharge
- Entered prior authorization data into the company's system via insurance portals, facilitating the claims department's billing and payment receipt operations
Benefit Verification Specialist
AmerisourceBergen
11.2015 - 03.2017
- Verified insurance coverage and ensured accurate processing for medications, facilitating timely access to critical care for patients
- Coordinated with healthcare providers, insurance companies, and pharmacies to gather patient information, submit Prior Authorizations and Appeals, and reconcile billing codes for claims rebilling
Education
Diploma - Medical Billing and Coding
Kaplan College
Arlington, TX08.2012
High School Diploma -
Jefferson High School
Jefferson, TX05.2003
Skills
- Insurance Verification
- Medicare/Medicaid and Commercial Payers
- Medical Scheduling
- Medical Terminology
- CPT
- Dme
- Icd-10
- HCPCS
- Customer Service
- Hipaa
- Collaboration and communication
- Microsoft Office
- Team leadership
- Word
- Quality assurance
- Excel
- PowerPoint
- Medisoft
- MD Online
- Computer and PC Savvy
- Multi-Tasking
- Customer Support
Timeline
QA Specialist
CareMetx (CornerStone Staffing)
12.2024 - Current
Coverage Determination Representative
CVS Health
10.2023 - 09.2024
Case Manager
RemX-McKesson
07.2022 - 05.2023
Customer Service Representative
CVS Health
10.2020 - 04.2022
Prior Authorization Specialist
Senderra RX Pharmacy
04.2017 - 10.2018
Benefit Verification Specialist
AmerisourceBergen
11.2015 - 03.2017
Diploma - Medical Billing and Coding
Kaplan College
High School Diploma -
Jefferson High School
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