Brooke Sharp Email & Phone Number

Work From Home

User Provisioning for approx 25,000 employees company wide to the MHK Nitro SystemProviding support to business partners for Medicare Appeals, Grievances and ComplaintsManaging projects of various complexity to completion Coordinating submission of plan communications to CMS for approvalSubmitting and tracking system technical issuesIntranet content and.

Work From Home

Providing auditing support to the Medicare Part D and Medicare Part B inbound call associates. Ensuring CMS compliance through reporting and analysisTrained new associates to the team in reporting and call quality auditingProvided a variety of training documents regarding reporting team daily processesObtained Yellow Belt Certification

Work At Home

-Processing various types of post-service appeals, dealing with administrative issues or questions of medical necessity-Gaining familiarity with CMS regulations in regards to the appeal process and the rights of members and providers -Meeting a quality standard of 95% accuracy and a production standard of 5-7 cases closed per week-Working efficiently to.

Harrisburg, Pennsylvania Area

• Loading and maintaining Simple, Intermediate and Complex Facility, Provider and Ancillary Contracts with a 99% accuracy rate
• Creating weekly summary reports for management detailing the status of contracts across entire health plans by utilizing reporting tools and Microsoft Excel
• Extracting data from the transactional database for analysis of contract setups
• Liason with Provider Relations, Provider Data Management, Customer Service and the Contract Testing Unit to clarify questions regarding contract and provider entry

• Duties Included:
• Processing provider and beneficiary appeals while adhering to the strict Center for Medicare and Medicaid Services (CMS) guidelines and turnaround times
• Using online sources such as the CMS website to verify proper billing and coding of procedures and services

• Working closely with staff pharmacists making determinations on medication authorizations based on plan guidelines
• Processing patient requests across three lines of Coventry business- Medicare, Medicaid and Commercial benefits
• Gaining proficiency in the indications and dosing of medical injectibles, including reviewing provider chart notes
• Reviewing the plan’s Medicare formularies for consistency and accuracy
• Working remotely, prioritizing tasks and meeting turnaround times without supervision

Harrisburg, Pennsylvania, United States

• Assisted providers with obtaining prior authorizations, formulary information and medication alternatives
• Reviewed incoming prior authorization fax documents and medical records across Commercial, Medicare and Medicaid lines of business
• Supervised the introduction of trainees to the phone system and coached until they reached a level of independence
• Produced training documents to update the department in procedure changes or reinforce policies

• Duties Included:
• Performing technician duties at both Lancaster General Hospital and The Women and Babies Hospital, Lancaster PA
• Refilling stock medications at Pyxis med stations throughout the hospital, including controlled substances
• Hourly rounds performing inventory management

• Duties Included:
• Completed CVS Pharmacy Technician training and took the Pharmacy Technician Certification Board exam while employed
• Data entry requiring a high degree of accuracy processing prescriptions
• Extensive customer service both in store and resolving formulary questions or coverage policy issues with insurance coverage
• Inventory management