Era Williams
Snellville,GA
Summary
Experienced with managing appeals processes efficiently and effectively. Strong written communication skills, including advanced skills and grammar and spelling. Experience with health care, medical and pharmacy terminology. Strong analytical skills. Ability to effectively communicate to facilitate smooth operations for client satisfaction.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Clinical Care Coordinator
United Healthcare Group
06.2022 - Current
- Conducting proactive research on assigned member accounts to identify service issues.
- Responsible for resolving customer inquiries, obtain additional documentation required fro case review.
- Coordinated, monitored, assigned and documented patient and clinical care activities.
- Communicating with assigned clinical and non-clinical staff regarding member service issues.
- Resolving member service inquiries related to benefits, claims, and eligibility.
- Educating members about health care benefits and maximizing value of their health plan
- Onboard training for incoming staff.
- Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
- Case Management handling over 70 calls per day.
Licensed Pharmacy Technician
GEMA
03.2020 - 11.2021
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency and service quality.
- Monitoring operation of vaccine storage equipment and systems Overseeing proper vaccine transport (when necessary) per standard operating procedures.
- Maintaining all documentation, such as inventory and temperature logs.
- Prepared doses for distribution by drawing syringes.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Coordinated verification and filling more than 400 prescriptions daily in high volume pharmacy.
Prior Authorization Specialist
Aetna Medicaid
02.2016 - 02.2018
- Input all patient data regarding claims and prior authorizations into system accurately.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Completed over 50 prior authorization approvals daily.
- Communicate appeal or grievance information to members or providers and internal/external parties within required timeframes.
Pharmacy Technician
Jackson Pharmacy Professionals
03.2014 - 02.2018
- Coordinate documentation to to improve access to needed medication assistance.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Entered and processed patients' prescriptions into internal system.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Counted, measured, and compounded medications following standard procedures.
- Coordinated verification and filling of more than 200 scripts daily prescriptions in high volume pharmacy.
Education
Associate of Arts - Communication Studies
University of Phoenix
Phoenix, AZ11.2009
Skills
- Case Management
- Database Coordination
- Insurance Practices
- Care Planning
- Proficiency in using multiple systems
- Resolve complaints
- Clinical Documentation
- Medicare Compliance
- Prior Authorization
- Licensed pharmacy technician
- Appeals/Denials
- CPT coding, ICD10
Accomplishments
Appointed Notary Public.
Resident Life Insurance Agent for the state of Georgia.
Certification
- Certified Sales Professional (CSP)
- Microsoft Office Specialist (MOS) Certification
Timeline
Clinical Care Coordinator
United Healthcare Group
06.2022 - Current
Licensed Pharmacy Technician
GEMA
03.2020 - 11.2021
Prior Authorization Specialist
Aetna Medicaid
02.2016 - 02.2018
Pharmacy Technician
Jackson Pharmacy Professionals
03.2014 - 02.2018
Associate of Arts - Communication Studies
University of Phoenix
Similar Profiles
Dorothy GhantDorothy Ghant
Care Navigator at United Healthcare GroupCare Navigator at United Healthcare Group
LAURYN RANDALLLAURYN RANDALL
Associate Claims Coordinator at United Healthcare GroupAssociate Claims Coordinator at United Healthcare Group
Nicole EdwardsNicole Edwards
Claims Adjuster at United Healthcare GroupClaims Adjuster at United Healthcare Group