J. Patrice Elliott
Rock Hill
Summary
Reimbursement Specialist with extensive experience in managing reimbursement tasks and resolving billing discrepancies. Proven ability to streamline processes and improve efficiency while maintaining compliance with industry standards. Valued team player who consistently achieves results through effective collaboration and adaptability. Experienced with pharmacy operations, medication dispensing, and regulatory compliance. Utilizes organizational skills to streamline workflow and enhance team performance. Track record of effective inventory management and patient interaction, ensuring high-quality service delivery. Eager to obtain a role with a company where I can maximize my customer service experience, communication skills, and problem-solving abilities.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Reimbursement Specialist
CareMetx
05.2023 - Current
- Supported company objectives by maintaining compliance with all relevant state and federal regulations governing medical billing practices.
- Contributed to increased team productivity by consistently meeting or exceeding individual processing goals.
- Coordinated with insurance providers to verify customer's policy benefits in relation to claims.
- Maintained patient confidentiality by adhering to strict HIPAA guidelines when handling sensitive information.
- Managed multiple priorities effectively under high-pressure deadlines without compromising accuracy or quality of work output.
- Demonstrated adaptability and a commitment to ongoing professional development, embracing new software systems and process changes with enthusiasm and ease.
- Developed a reputation for expertise in handling complex reimbursement cases, becoming a go-to resource within the team for assistance in problem-solving difficult scenarios.
Clinical Review Technician
Aston Carter- Prime Therapeutics
08.2021 - 03.2022
- Escalated unresolved patient and caregiver issues to the appropriate teams to ensure a quick turnaround time and resolution
- Effectively processed caseload with some level of oversight of moderately complex claims which consists of pending, ongoing/active and appeal reviews
- Analyzed information to determine if additional information was needed to make a reasonable and logical claims determination based off the information available
- Researched and resolved questions, problems, or issues to determine if the request can be approved
- Outreached to the provider’s office for discrepancy and missing information and track information on tracking tool
- Provided all relevant clinical information specific to a prior authorization request to the Clinical Review Pharmacist and the physician for claims not approved
- Provided timely, balanced, and accurate claims reviews, documentation, and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations
- Provided timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination to the member and/or physician
- Effectuating authorizations (e.g., prior authorization overrides) at the drug-specific level to ensure the appropriate claims will adjudicate and validate with test claims
- Properly processed, communicated, documented, and tracked requests for various prior authorizations for delegated utilization management (UM) products and services
- Demonstrated adaptability when faced with new challenges or technologies, enabling quick mastery of necessary skills.
Lead Pharmacy Technician
Wal-Mart Pharmacy
South Charlotte, NC
02.2012 - 12.2020
- Supervised 15 pharmacy technicians and coordinated day-to-day assignments.
- Promoted teamwork among pharmacy staff, fostering a collaborative environment for improved productivity.
- Maintained and updated patient records, prescription information and patient data in accordance with HIPAA regulations.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Optimized inventory management, regularly reviewing stock levels and placing timely orders to prevent shortages or overstocking issues.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Maintained compliance with all federal and state regulations related to pharmaceutical operations, ensuring accurate record-keeping and documentation practices.
- Developed strong relationships with healthcare providers, facilitating efficient communication regarding prescription clarifications and adjustments.
- Assisted pharmacists in conducting medication therapy management consultations, enhancing patient understanding of their treatment plans.
- Participated in outreach efforts such as community health fairs to raise awareness of the pharmacy''s services and offerings.
Customer Service Representative
Adecco - Shutterfly
06.2020 - 11.2020
- Demonstrated proficiency with Salesforce, Google, Microsoft Teams, Outlook, Excel, Word, and Shutterfly.com
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Contributed to sales growth by upselling products and services based on individual customer requirements.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Enhanced customer loyalty by offering personalized solutions tailored to individual needs.
- Maintained detailed records of customer interactions and transactions, ensuring accurate documentation and follow-up.
- Fostered positive customer service culture within team which led to higher customer satisfaction rates.
- Participated in cross-functional teams to discuss ways to improve overall customer satisfaction across company.
Education
Human Resources Management
Western Governors University
Salt Lake City, UT12-2026
Certified Pharmacy Technician -
02.2025
Associate in Applied Science - Administrative Office Technology
York Technical College
Rock Hill, SC05.2021
Skills
- HIPAA compliance
- Insurance verification
- Medicare & Medicaid
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Multitasking
- Verbal and written communication
- Documentation skills
- Quality assurance management
Certification
- Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board (PTCB).
Timeline
Reimbursement Specialist
CareMetx
05.2023 - Current
Clinical Review Technician
Aston Carter- Prime Therapeutics
08.2021 - 03.2022
Customer Service Representative
Adecco - Shutterfly
06.2020 - 11.2020
Lead Pharmacy Technician
Wal-Mart Pharmacy
02.2012 - 12.2020
Human Resources Management
Western Governors University
Certified Pharmacy Technician -
Associate in Applied Science - Administrative Office Technology
York Technical College