Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Veranique Pruitt

Chicago,IL

Summary

Promoted multiple times at CVS Health, reaching the position of Appeals & Grievances Specialist III. Known for streamlining grievance processes, reducing case backlogs, and enhancing client retention and satisfaction through strong problem-solving and time management skills. Demonstrated expertise in customer relations and HIPAA compliance. Improved patient outcomes by 22% through efficient customer service.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Appeals & Grievances Specialist III

CVS Health
Remote
09.2021 - 01.2024
  • Enhanced service delivery during grievance appeals led to a 75% increase in client retention rates.
  • Demonstrated exceptional time management skills in efficiently handling multiple high-priority cases simultaneously while maintaining meticulous attention to detail.
  • Diligently reviewed and resolved pending grievances, leading to a significant 60% reduction in case backlog.
  • Achieved financial targets and reduced outstanding debt by resubmitting edited or denied claims
  • Identified inconsistencies and malfunctions through quality control oversight.

Lead Pharmacy Claims Specialist

CVS Health
Remote
08.2019 - 09.2021
  • Promoted to the role of Grievance/Appeal Specialist due to consistent high performance, attention to detail, effective time management skills, and strong decision-making abilities.
  • Streamlined claims processing procedures, resulting in significant reductions in turnaround times and increased client satisfaction.
  • Demonstrated critical thinking and negotiation skills to fairly settle high-volume, complex claims in accordance with insurance policies.
  • Achieved 80% decrease in claim processing errors, through conducting comprehensive investigations and precise policy interpretation.

Pharmacy Claim Specialist II

CVS Health
Mount Prospect, IL
08.2017 - 08.2019
  • Handled complex pharmacy claims tasks resulting in promotion to Lead Pharmacy Claim Specialist.
  • Achieved 76% increase in customer satisfaction through prompt and accurate claim resolutions, garnering positive feedback and enhancing client retention.
  • Accurately reviewed and organized claim files with all necessary documents for reference

Prior Authorization Pharmacy Technician

CVS Health
Mount Prospect, IL
12.2015 - 08.2017
  • Demonstrated exemplary proficiency in managing intricate responsibilities leading to a well-deserved elevation to the role of Pharmacy Claims Specialist II.
  • Enhanced patient satisfaction by 40% through precise handling of prior authorization requests and cooperation with healthcare providers.
  • Developed 48-hour workflow for prior authorization follow-up.
  • Managed the input of prescription orders, patient profiles, and prior authorizations into pharmacy software system.

Patient Service Specialist

Chicago Lighthouse for the Blind/UI Health
Chicago, United States, IL
10.2013 - 12.2015
  • Coordinated appointments, referrals, laboratory tests, and medical records to support healthcare providers in patient care management.
  • Ensured accurate billing procedures by verifying insurance coverage for all visits.
  • Handled incoming calls from patients and healthcare professionals, offering prompt assistance and information.
  • Monitored prescription refills and sought essential insurance approvals.

Education

Diploma: Clinical Medical Assistant - Certified Registered Medical Assistant

Illinois School of Health Careers - Chicago
Chicago, IL
06.2011

High School Diploma -

DuSable High School
Chicago, United States
06.2002

Skills

  • HIPPA Compliance
  • Problem-Solving
  • Customer Relations
  • Quality Assurance
  • Issue Research
  • Communication
  • Team Collaboration
  • Multitasking
  • Time management
  • Proficient with all Microsoft Office Software

Certification

  • National Certified Pharmacy Technician (NCPhT) - National Healthcareer Association (NHA).
  • Certified Medical Assistant (CMA) - American Association of Medical Assistants (AAMA).

Timeline

Appeals & Grievances Specialist III

CVS Health
09.2021 - 01.2024

Lead Pharmacy Claims Specialist

CVS Health
08.2019 - 09.2021

Pharmacy Claim Specialist II

CVS Health
08.2017 - 08.2019

Prior Authorization Pharmacy Technician

CVS Health
12.2015 - 08.2017

Patient Service Specialist

Chicago Lighthouse for the Blind/UI Health
10.2013 - 12.2015

Diploma: Clinical Medical Assistant - Certified Registered Medical Assistant

Illinois School of Health Careers - Chicago

High School Diploma -

DuSable High School

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Veranique Pruitt