Lori Waddell

Lori Waddell resume 5 28 … Lori Waddell Bristol, VA- |-| www.linkedin.com/in/lori-waddell-b Professional Profile Experienced Healthcare Case Manager with over 10 years in the healthcare industry, specializing in customer service, benefit administration, and case management. Proven record of streamlining processes to improve productivity and reduce turnaround times for patient care coordination. Adept at navigating complex healthcare systems to deliver efficient, patient centered solutions. Seeking to leverage expertise in Case Management, Patient Care Coordination, or Healthcare Administration role to enhance care delivery and operational efficiency. Core Competencies: ● Healthcare Case Management ● HIPAA Compliance ● Patient Advocacy & Support ● Cross Functional Collaboration ● Benefit Verification and Administration ● Time Management and Prioritization Work Experience Eversana Specialty Pharmacy, Overland, Park, KS 01/2025-04/2025 Eversana focuses on being a leading provider of global commercialization services to the life sciences industry. Focusing on patient engagement, adherence, and specialty pharmacy services. CASE MANAGER Responsible for coordinating benefit investigations, facilitating prior authorizations and serving as a primary liaison between patients, providers, and payers. : ● Proactively identifies procedure improvement opportunities to streamline workflows, reduce turnaround time, and enhance the overall patient experience. ● Streamlined case management workflows, resulting in a 25% reduction in patient care turnaround times. ● Successfully coordinated benefits and prior authorizations for high-cost specialty medications, assuring timely treatment initiation. ● Consistently maintained a 95%+ patient satisfaction rating through effective communication and compassionate support. ● Led process improvements to increase team productivity and reduce administrative delays by identifying system Edit with thebottlenecks. Docs app ● Collaborated cross-functionally with providers, payers, and internal departments to resolve complex issues. Makereimbursement tweaks, leave comments, and share with others to edit at the same time. LUMINARE HEALTH, Lancaster, PA 04/2022-12/2024 Luminare Health focuses on helping self-funded employers manage their healthcare costs, supporting clients’ strategic growth and empowering members to live healthier lives. NO THANKS GET THE APP Benefit Verification Specialist Responsible for verifying patient insurance coverage, identifying benefit eligibility, and securing prior authorizations to secure timely access to prescribed treatments. ● Serves as a key liaison between patients, providers, and payers to resolve benefit related issues and minimize delays in care. ● Verified insurance benefits an average of 50+ patients daily, ensuring accuracy and compliance with payer requirements. ● Reduced prior authorization turnaround times by 30% through proactive communication with insurance providers and clinical teams. ● Successfully assured approvals for high-cost specialty medications, improving patient access to critical therapies. ● Maintained a 98% accuracy rate in benefit verification, minimizing billing errors and reimbursement delays. ● Recognized by leadership for attention to detail, documentation accuracy, and excellent customer service to providers and patients. CVS CAREMARK Woonsocket, RI 10/2016 – 03/2022 CVS Caremark focuses on being a comprehensive healthcare partner, providing services that improve health outcomes, lower costs, and enhance overall healthcare experience for members, clients, and patients. Coverage Determinations and Appeals Representative Functioned as a key liaison between patients, providers, and insurance carriers to ensure appropriate access to prescribed medications and treatments. ● Demonstrated strong knowledge of Medicare Part D, commercial insurance plans, and appeals procedures. ● Delivered timely, accurate, decisions while maintaining high levels of customer service and a consistent record of meeting or exceeding turnaround time and quality review metrics in a highvolume environment. ● Resolved an average of 70+ coverage determination and appeal cases per week with a 97% compliance rate to CMS payer guidelines. ● Successfully overturned denials in complex appeal cases by compiling and submitting thorough clinical justifications, resulting in improved patient access to medications. ● Reduced case execution time by 20% by identifying workflow inefficiencies and suggesting improvements to standard operating procedures. ● Recognized by leadership for attention to detail, accuracy in documentation and communication, outstanding customer service, 100% attendance, and impeccable patient care. ● Trained and mentored new team members, contributing to faster onboarding and improved team performance. PRIME THERAPEUTICS, Eagan, MN 01/2011-09/2016 Prime Therapeutics is a Pharmacy Benefit Manager that manages pharmacy benefits for health plans, employers, and government programs. Remote Pharmacy Technician Supported pharmacists in processing prescriptions, managing mediation orders, and ensuring compliance with state and federal regulations. ● Utilized pharmacy management systems to perform data entry, verify insurance information, and facilitate prior authorizations. ● Demonstrated strong communication and organizational skills while collaborating with healthcare professionals, patients, and insurance providers to deliver accurate and timely medication dispensing. ● Contributed to a 20% improvement in order turnaround time by identifying workflow inefficiencies and recommending remote procedure optimizations, delivering high-quality service in a virtual environment. Education Bachelor of Science in Health Services Management, Independence University, Salt Lake City, UT -2019 : Certifications and community involvement Pharmacy Technician Certification, Missouri, 2025 Treasurer for Healthcare Workers of America Bristol, VA (2019 – Present) :