Trista Howard
Altamonte Springs,FL
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Medical Authorization Claims/Medical Authorization/Appeals and Grievances Coordinator
Kroger Specialty Pharmacy
11.2019 - Current
- Acted as a departmental resource on appeal/PA matters.
- Created, composed and maintained appeal/PA response templates.
- Developed appeals functions, policies and procedures and documentation.
- Organized and managed appeals/PA caseloads, prioritizing high-priority cases for timely resolution.
- Coordinated with medical professionals and subject matter experts for case reviews, obtaining necessary clarification for accurate decision making.
- Streamlined appeals process for increased efficiency through consistent tracking and monitoring of cases.
Client Advocate (Claims Management) II
The Advocator Group
04.2017 - 11.2019
- Assisted individuals and corporations in obtaining Social Security Disability and Medicare/Medicaid benefits for individuals who are facing financial hardship due to new or pre-existing disability and were no longer able to sustain gainful employment
- Services provided but not limited to; award strategies, professional case advocacy, assistance with applications/ claim filing, questionnaires and appeal forms, case monitoring, status updates and, provided overall education to clients on process of filing for SSDI and or SSI
- Completed hearing preparation files, submitting pre/post hearing briefs as necessary, and submitted proper level appeals on case by case basis
- Assisted on escalation team
- Managed quality assurance program, including on-site evaluations, internal audits and customer surveys
- Developed team communications and information for meetings
Pharmacy Services Supervisor Work From Home
CVS Specialty Pharmacy
10.2014 - 04.2017
- Successfully lead team of 15 work from home provider service representatives
- Interacted closely with pharmacy, operations and reimbursement departments as well as staff at various treatment centers, and physicians
- Answered calls from and communicated with customers or caregivers to review inventory levels of product and supplies as needed
- Document and communicate medical problems or service issues experienced by customer to appropriate clinician or supervisor
- Conducted Monthly reviews of PSR's stats and provided coaching opportunities as necessary in accordance with company quality assurance guidelines
- Benefits Verification and Insurance investigation (Prior Authorizations) - Routing calls to appropriate department(s) - Entering accurate information into multi-screen computer application
- Providing expertise and customer service to members or providers relating to enrollment, completing refills of prescription orders, discussing benefits, and any/all other questions in regards to member's specialty medication
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows to meet any daily demand
Education
Some College (No Degree) - Psychology
Seminole State Community College
Sanford, FLHigh School Diploma -
Edgewater High School
Orlando, FL05.2007
All Line Adjuster 6-20 - Claims Adjuster
UCF
Orlando, FL05.2021
Skills
- Benefits
- Quality Assurance
- SSI/SSDI/Medicaid/Medicare Expert
- Supervisor
- Claims Management
- Claims investigation and research
- Data collection and management
- Dispute Resolution
Certification
Commissioned Notary in the State of Florida: Commission # GG242404
Timeline
Medical Authorization Claims/Medical Authorization/Appeals and Grievances Coordinator
Kroger Specialty Pharmacy
11.2019 - Current
Client Advocate (Claims Management) II
The Advocator Group
04.2017 - 11.2019
Pharmacy Services Supervisor Work From Home
CVS Specialty Pharmacy
10.2014 - 04.2017
Some College (No Degree) - Psychology
Seminole State Community College
High School Diploma -
Edgewater High School
All Line Adjuster 6-20 - Claims Adjuster
UCF
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