Tracey Richards

Remote-ready healthcare operations professional with 20+ years of experience across claims processing, prior authorization, pharmacy services, patient support, case management, customer service, and government health programs. Experienced working directly with commercial insurance, Medicaid, and Medicare Part A, B and D. Strong knowledge of RxClaims, Epic and healthcare technology platforms, with working knowledge of ICD-9, ICD-10 and HCPCS coding terminology.

Proven ability to research complex cases, obtain documentation, resolve discrepancies, communicate with providers, members and insurers, and meet demanding accuracy and productivity metrics.

Clinical Coordinator - Wipro

(2025-09)

• Process claims for procedures, services, and durable medical equipment with a strong focus on accuracy, turnaround time, and payer requirements.
• Obtain prior authorizations by gathering required clinical and administrative information and processing requests from initiation through completion.
• Coordinate requests requiring medical director review and communicate with providers and insurance representatives to resolve missing information or authorization issues.
• Consistently work within daily and hourly production expectations while maintaining quality and documentation standards.

Case Manager - Biogen

(2024-08 - 2025-03)

• Managed patient cases for multiple sclerosis therapies, helping patients navigate medication-access and insurance barriers.
• Coordinated with providers, pharmacies, and insurers to resolve coverage and access issues.
• Completed prior authorizations and handled insurance escalations.
• Reported adverse drug reactions to the FDA in accordance with applicable requirements.

Prior Authorization Specialist - Prime Therapeutics

(2022-11 - 2024-08)

• Processed prior authorizations from start to finish across pharmacy and medical benefits.
• Worked with providers to gather required documentation and move authorization requests toward timely decisions.
• Supported Medicare, Medicaid, and hospice populations while following payer and healthcare policies.
• Maintained detailed documentation and compliance with healthcare regulations.

Legislative Claims Agent - Accenture

(2021-03 - 2022-10)

• Processed high-priority government-escalated claims accurately and efficiently.
• Investigated and resolved claim discrepancies using established research and workflow procedures.
• Trained new hires on systems, processes, and workflows.

Health & Human Services Case Worker - Accenture

(2019-09 - 2021-03)

• Assisted clients with Medicaid and SNAP applications and related documentation.
• Managed case information and ensured accurate processing of required materials.
• Provided customer support through phone, email, and chat.

Guest Engagement Specialist - Hilton Worldwide

(2018-01 - 2019-08)

• Handled high-volume inbound customer contacts and delivered professional service.
• Consistently worked toward and exceeded performance metrics while resolving customer needs.
• Identified opportunities to upsell services while maintaining a positive customer experience.

Executive Assistant - GSA Greenville

(2012-03 - 2017-12)

• Guided small businesses through the federal contracting process and provided administrative support.
• Achieved top sales-performer status for six consecutive months.

Pharmacy Technician - Pharmacy Consultants

(2008-05 - 2012-01)

• Managed insurance billing and prior authorizations for long-term-care pharmacy services.
• Coordinated with providers and insurers to support medication access and resolve coverage issues.

Pharmacy Technician - Walgreens

(2004-05 - 2010-11)

• Processed prescriptions and insurance billing while supporting day-to-day pharmacy operations.
• Trained new staff and supported accurate, efficient pharmacy workflows.