Brittany Truelove
Indianapolis
Summary
Professional with extensive experience in managing appeals processes within healthcare sector. Known for strong analytical skills, effective communication, and ability to navigate complex regulatory environments. Proven track record in fostering team collaboration, adapting to changing requirements, and achieving results. Well-versed in conflict resolution, data analysis, and workflow optimization. Reliable and adaptable with focus on delivering high-quality outcomes.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Pharmacy Appeals Coordinator II
MDwise, Inc.
Indianapolis, IN
11.2016 - Current
- Oversaw comprehensive review of pharmacy appeal requests, conducting data entry and research to facilitate timely authorization decisions for members and providers.
- Achieved effective communication with members, providers, and MDwise staff on critical topics. Streamlined requests for clinical information from providers. Articulated appeal rights and decisions to members. Enhanced resolution of pharmacy benefit inquiries for MDWise staff.
- Facilitated documentation gathering from PBM systems to support clinical review of pharmacy appeal cases in compliance with NCQA, CMS, and FSSA requirements.
- Coordinated key work processes, ensuring seamless transfer of medical drug reviews and compliance with NCQA audit standards.
- Ensured accountability in pharmacy appeal tasks, meeting and exceeding NCQA, state, and MDwise standards.
- Managed appeals process efficiently, ensuring timely resolutions for complex cases.
- Coordinated communication between departments to streamline appeal workflows.
- Analyzed documentation for compliance with regulatory requirements, enhancing accuracy of submissions.
- Developed training materials for staff on appeals procedures and best practices.
- Led cross-functional teams to improve appeal turnaround times and customer satisfaction rates.
- Mentored junior staff in case management techniques and effective dispute resolution strategies.
- Acted as a departmental resource on appeals matters.
- Created, composed and maintained appeal response templates.
- Developed appeals functions, policies and procedures and documentation.
- Developed strong working relationships with internal and external stakeholders, fostering a collaborative environment for efficient resolution of appeals.
- Participated in regular meetings with management to provide updates on case status and discuss potential improvements in processes.
Pharmacy Technician
CVS Health
Fishers, IN
02.2013 - Current
- Managed patient information entry and prescription translation into software system to ensure precision in claims handling.
- Versatile multitasking between pharmacy pick-up, production, and drop-off with attention to detail in a fast-paced, high-volume retail setting
- Managed medication inventory and ensured compliance with regulatory standards.
- Processed prescription orders accurately while minimizing errors in a fast-paced environment.
- Capable of carryout out pharmacy duties independently and has a full understanding of required pharmacist intervention
- Providing friendly customer service in all areas while safeguarding patient confidentiality
- Monitored and maintained drug inventory levels while conducting daily follow-ups to support patient therapy compliance and meet monthly care objectives.
- Lead Tech specific duties included training new personnel, scheduling, leading other technicians by example, assisting in various audits, and helping to maintain a solid workflow in the pharmacy to ensure timely and accurate filling of prescriptions
Specimen Processing Specialist
Mid-America Clinical Lab
11.2008 - 11.2012
- Oversaw specimen acceptance and sorting processes to enhance operational efficiency. Coordinated workflow among specimen processors to optimize productivity. Facilitated timely delivery of specimens to technical departments for analysis.
- My daily responsibilities are to translate doctor's orders into proper tests, label specimens correctly and verify specimen type is accurate, check Specimen Processor I's data entry for errors, and maintain a 130% productivity count.
- Processed biological specimens in compliance with regulatory standards and protocols.
- Collaborated with laboratory staff to ensure timely specimen handling and analysis.
Inspection and Quality Control
OFS Brands
05.2006 - 08.2008
- Everyday duties included but were not limited to daily inspections of all high dollar conference tops (including conference pieces with values often exceeding $50,000), making decisions with other QC when problems in the plant occurs, documenting all jobs performed and pieces looked at, communicating decisions with other employees and shifts, reviewing returned material and comparing dollars actually shipped and orders that were supposed to be shipped.
Education
Bachelor of Science - Criminal Justice, Geography
Indiana University
08.2020
Skills
- Managed Medicaid expertise
- Comprehensive understanding of medical terminology
- Extensive experience with HIPAA/HITECH/PHI, CMS, NCQA, FSSA, state and federal pharmacy regulations/accreditations
- Proficient in analytical problem resolution
- Experience with Microsoft Office, ArcGIS database and queries, PBM systems, Jiva Healthcare system, Healthedge Solutions Suite
- Data entry proficiency
- Policy interpretation
- Confidentiality
- Effective communication
- Strong analytical skills
- Documentation expertise
- Teamwork and collaboration
- Claims investigation
- Multitasking Abilities
- Organizing and prioritizing work
- Attention to detail
- Problem-solving abilities
- Critical thinking
- Organizational skills
- Active listening
- Adaptability and flexibility
- Decision-making
- Claims processing/Claims adjustment
- Reporting skills
- Self motivation
- Interpersonal skills
- Analytical thinking
- Prior authorization processing
- Coverage determination
- Quality control
- Time management abilities
- Adaptability
- Insurance regulations
Certification
- Certified Pharmacy Technician (CPhT), Pharmacy Technician Certification Board
- Earned in May 2016
- License Number 30009014
- Indiana State Board of Pharmacy, Pharmacy Technician License
- Earned in March 2013
Timeline
Pharmacy Appeals Coordinator II
MDwise, Inc.
11.2016 - Current
Pharmacy Technician
CVS Health
02.2013 - Current
Specimen Processing Specialist
Mid-America Clinical Lab
11.2008 - 11.2012
Inspection and Quality Control
OFS Brands
05.2006 - 08.2008
Bachelor of Science - Criminal Justice, Geography
Indiana University
Employee of the Month x3
Nominated by peers and selected by leadership once in 2018 and twice in 2024