Whitney Hughley
Troy University
From Birmingham, AL
From Birmingham, AL
Professional Summary
A detailed-oriented worker with extensive knowledge of Medicaid and Medicare procedures. 4 years of pharmacy experience. Motivated to deliver exceptional customer service proven to result in successful business outcome. State registered and PTCB certified, with strong communication skills, excels in teamwork, conflict resolution and making sound decisions under pressure.
Skill Highlights
PTCB (2011)
Experienced in processing Medicare and Commercial claims
Knowledge of HIPAA regulations
Strong attention to detail
Knowledge of CMS systems such as STARS and HEDIS measurements
45-55 wpm
Ability to communicate effectively with others verbally and strong writing skills
Ability to work well under pressure and within time constraints
Experience with Microsoft Access, Word, Excel, PowerPoint and Outlook
Follow Whitney
Troy University
Notasulga High School
Whitney Hughley named to Troy University Chancellor's List
Whitney Hughley of Birmingham, AL, has been named to the Chancellor's List at Troy University for Term 3 of the 2014/2015 academic year. The Chancellor's List honors full-time undergraduate studen...
March, 18 2015 - Verified by Troy University
Coverage Determination Analyst at VIVA Health
-Processes Medicare and Commercial prior authorization and exception claims while steering members and doctor’s offices away from high risk medications for healthcare management of members.
-Participates in New to Therapy calls for patient assistance of disease state management such as hyperglycemia, hypertension, and hypercholesterolemia as STARS adherence measures.
Responsible for production and correction of requested documentation from CMS during and prior to audits.
-Trains temporary employees of the Pharmacy Department for peak season coverage of prior authorizations.
-Assist pharmacist in gathering and maintaining PA Criteria for comparison with competitors.
September 2013 - Present
