Deanna Cooley Email & Phone Number

Chicago, Il, Us

Chicago, Illinois, United States

Collect and review all submitted records related to pharmacy and/or medical prior authorization requests when the queue exceeds normal capacity.Arrange single case agreements, negotiate pricing, accurately process claims, and update all notes within the member’s associated QicLink page.Execute, manage, and provide on-going support of single case agreements.Assist and collaborate with Customer Service to improve processes, communications, and service between members, facilities, and vendors.Submit member referrals to third-party vendors managing specialty carve-out programs.Serves as liaison for external vendors when implementing specialty carve-out programs.Reviews current and newly requested vendor plan language to understand impact with governmental regulations.Ensure ongoing knowledge and compliance with all contracts beyond initial implementation and throughout the full revenue cycle.Collaborate with Plan Building, Customer Service, and other internal departments on the development and implementation of policies and group plan language related to a vendor.Management of escalated questions and status updates related to vendor relationships for the Client Executive, Client Service, and Customer Service teams.

Chicago, Illinois, United States

Exhibit knowledge of the general comprehension of pharmacy and medical benefits.Collect and review all submitted data related to pharmacy and/or medical prior authorization requests (PAs)Supports and resolves insurance related issues when applicableResolve any customer requests in a timely and accurate manner; escalates complaints accordingly

Chicago, Illinois, United States

Chicago, Illinois, United States

Repriced CMS1500 and UB04 forms for various PPO networks.Used several different computer applications to obtain the information needed to correctly re-price a claim.Key claims once repriced into the Rims system.Communicated effectively with various departments to resolve issues to minimize escalations.Repriced and key claims at a minimum of 99% accuracy.Analyzed current processes and develop ways to improve those processes.

Chicago, Illinois, United States

Aided pharmacist in daily prescription filling duties.Maintained the pharmacy by restocking drug inventory and supplies.Assisted patients through their checkout process and answered questions regarding their refill process.Coordinated shipping of maintenance medications to prevent noncompliance of medication adherence.

Chicago, Illinois, United States

Prepared medications for provider dispensing the medication in accordance to prescription.Processed refills on a daily basis.Ordered pharmaceuticals and receive/stock drugs.Complete pharmacy reports not limited to inventory reports and expired medications as detailed in Medication Technician Handbook.Worked with corporate team to keep center updated with processes and procedures.Collected patient information for prescription and billing.Kept filing system updated for multiple procedures/processes.Assisted with pharmacy claims adjudication including calling insurances to assess and correct pharmacy claims rejections if appropriate.