Field Reimbursement Manager

• May 2020 - Present

Patient Access Consultant

• May 2019 - May 2020

Being a master of all reimbursement activities, claim submissions, claim statues, appeals, patient assistance and copay assistance,Analyzing,reporting and resolving any reimbursement trends/delays, Engaging with manufacturer representatives regarding payer profiles and reimbursement trends,Coordinating services with field reimbursement teams and sales representatives,Provding training and support to associates on the team, Being a master of all reimbursement activities, claim submissions, claim statues, appeals, patient assistance and copay assistance,Analyzing,reporting and resolving any reimbursement trends/delays, Engaging with manufacturer representatives regarding payer profiles and reimbursement trends,Coordinating services with field reimbursement teams and sales representatives,Provding training and support to associates on the team,

Senior Specialty(IVIG)Representative

• Jul 2017 - Apr 2019

Complied and adhered to HIPPA, PHI, PII and PCI standards during the execution of all engagements performed,Acts as a liaison between physicians and patients ,Enter insurance pre-certification /Understanding EOBS ,Process orders from referral sources and patients responding to phone and fax inquires,Scheduling nursing visits/Medication deliveries,Assist in orientation of staff,Manage voicemails, incoming calls,Tracks referrals according to specified timelines and notifies providers and families of determination/ authorization or denials from insurance.,Gathers clinical information,Prepares reports and documents for referrals,Research and resolve patient/customer questions,Relay insurance coverage to referral source and discuss forms required for billing with patients,Assist and educate members by answering questions regarding Copays, deductibles, and co-insurance

Certified Pharmacy Technician II

• Oct 2016 - Jul 2017

Educate members on medication as related to prescriptions,Advise members of available resources and assistance programs,Enters and validates information on member prescriptions and review claims,Place out bound and receive inbound calls ,Receives telephone inquiries from callers and transfers or refers to appropriate department,Handles a high volume of calls and adjusts skills to meet quality and productivity expectations,Confirms medication list including over the counter medication, herbal remedies and supplements,Maintains Performance and quality standards based on established call center metrics including turnaround times

Sr. Prior Authorization Billing Specialist

• Mar 2016 - Oct 2016

Performs insurance verification of benefit coverage on all patients’ insurance plans for each service being provided,Obtains and documents in the system all information related to coinsurance copay deductibles authorization requirements,Creates documentation required to service the patient per policy and payer guidelines,Determines estimated patient financial responsibility using insurance verification information and payer contracts and or self-pay guidelines,Obtains reauthorization as necessaryRun test claims and determine patient coverage/responsibility for services,Maintain excel spreadsheets

Lead Certified Pharmacy technician

• Dec 2011 - May 2016

Maintains pharmacy inventory by checking pharmaceutical stock to determine inventory level; anticipating needed medications and supplies; placing and expediting orders; verifying receipt; removing outdated drugs. Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations. Help health care providers and patients by greeting them in person and by phone; answering questions and requests; referring inquiries to the pharmacist. Organize medications for pharmacist to dispense by reading medication orders and prescriptions; preparing labels; calculating quantities; assembling intravenous solutions and other pharmaceutical therapies.

Senior Admissions Representative

• Nov 2014 - Mar 2016

Complied and adhered to HIPPA, PHI, PII and PCI standards during the execution of all engagements performed,Acts as a liaison between physicians and patients,Enter insurance pre-certification /Understanding EOBS ,Process orders from referral sources and patients responding to phone and fax inquires,Scheduling nursing visits/Medication deliveries,Assist in orientation of staffManage voicemails, incoming calls,Tracks referrals according to specified timelines and notifies providers and families of determination/ authorization or denials from insurance,Gathers clinical information,Prepares reports and documents for referrals,Research and resolve patient/customer questions,Relay insurance coverage to referral source and discuss forms required for billing with patients,Assist and educate members by answering questions regarding Copays, deductibles, and co-insurance