Lavesha Crutcher

Reimbursement Specialist

The Cigna Group

Oct 2024 - Apr 2026 (1 year 7 months)

• Manage and resolve high-volume reimbursement claims for specialty medications and prior authorizations • Investigate and overturn claim denials, improving reimbursement outcomes and reducing revenue loss • Collaborate with payers, providers, and internal teams to resolve complex billing and coverage issues • Ensure compliance with payer policies, coding standards, and federal healthcare regulations • Maintain detailed documentation supporting audits and successful claim approvals

Specialized Insurance Authorization

Ensemble Health Partners

Aug 2023 - Oct 2024 (1 year 3 months)

• Processed 50+ prior authorization requests daily across multiple payer types • Verified insurance eligibility and benefits, ensuring services met coverage requirements • Reviewed clinical documentation to support medical necessity and authorization approvals • Reduced authorization delays and denials through proactive follow-ups and accurate submissions • Coordinated with providers and insurance carriers to secure timely approvals

A

Eligibility Specialist

Accredo Health Group Express Scripts Cigna

Sep 2020 - Mar 2023 (2 years 7 months)

• Managed 45–60 specialty pharmacy cases daily involving complex medication approvals • Served as Subject Matter Expert (SME) and TAPP-trained specialist supporting team operations • Processed insurance verifications, claims, and authorization requests with high accuracy • Resolved denied claims and benefit issues through detailed research and payer communication • Generated EDI reports to support timely filing and reimbursement resolution

D

Eligibility Clerk

Department of Human Resources

Jun 2019 - Sep 2020 (1 year 4 months)

• Determined eligibility for government healthcare programs and benefits • Processed applications and maintained confidential records in compliance with regulations • Educated clients on program requirements and resolved eligibility inquiries

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