Experience

Phoenix Healthcare LLC

• Pharmaceutical Manufacturing
• 1 - 100 Employee

• Customer Service Representative

  • May 2017 - Present

  Contracted co-pay assistance representative Responsibility includes verification of patient information and eligibility to obtain copay assistance for high-end medications. To assist and provide pharmacists with information that will allow adjudication of secondary claims for same medications. Contracted co-pay assistance representative Responsibility includes verification of patient information and eligibility to obtain copay assistance for high-end medications. To assist and provide pharmacists with information that will allow adjudication of secondary claims for same medications.



ACS Specialty Pharmacy

• United States
• Pharmaceutical Manufacturing
• 1 - 100 Employee

• Billing Representative II

  • Jul 2014 - Feb 2015

  Part D collections for specialty pharmacy. Part D collections for specialty pharmacy.



Express Scripts

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Reimbursement Specialist

  • Aug 2010 - Jul 2014

  Temporary contractor adjudicating claims for patients that had co-pay assistance Collection calls for past due balances due from the programs Permanent position offered and hired in March 2011 Initial book of business was to collect from payers from agencies that dealt with the HIV patients. Appealed short payments, denials and reported monthly bad debt reports to supervisor. Final book of business give was to work with the California Department of Managed Care and obtain a… Show more Temporary contractor adjudicating claims for patients that had co-pay assistance Collection calls for past due balances due from the programs Permanent position offered and hired in March 2011 Initial book of business was to collect from payers from agencies that dealt with the HIV patients. Appealed short payments, denials and reported monthly bad debt reports to supervisor. Final book of business give was to work with the California Department of Managed Care and obtain a high balanced A/R from Independent Physician Associations. Also collected for current A/R for IPA and reported bad debt monthly to supervisor. Show less Temporary contractor adjudicating claims for patients that had co-pay assistance Collection calls for past due balances due from the programs Permanent position offered and hired in March 2011 Initial book of business was to collect from payers from agencies that dealt with the HIV patients. Appealed short payments, denials and reported monthly bad debt reports to supervisor. Final book of business give was to work with the California Department of Managed Care and obtain a… Show more Temporary contractor adjudicating claims for patients that had co-pay assistance Collection calls for past due balances due from the programs Permanent position offered and hired in March 2011 Initial book of business was to collect from payers from agencies that dealt with the HIV patients. Appealed short payments, denials and reported monthly bad debt reports to supervisor. Final book of business give was to work with the California Department of Managed Care and obtain a high balanced A/R from Independent Physician Associations. Also collected for current A/R for IPA and reported bad debt monthly to supervisor. Show less



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Claims Specialist Specialty Pharmacy

  • Aug 2007 - Jul 2011

  Claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Review and adjudicate routine claims in accordance with claim processing guidelines. Analyze routine claims that cannot be auto adjudicated. Complete eligibility verification and identify discrepancies in order to assist with adjudication. Coordinate responses for routine… Show more Claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Review and adjudicate routine claims in accordance with claim processing guidelines. Analyze routine claims that cannot be auto adjudicated. Complete eligibility verification and identify discrepancies in order to assist with adjudication. Coordinate responses for routine phone inquiries and written correspondence related to claim processing issues. Route and triage complex claims to Senior Claim Benefits Specialist; proof claims or referral submissions to determine, review or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. Utilize all applicable system functions available ensuring accurate and timely claim processing service. Show less Claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Review and adjudicate routine claims in accordance with claim processing guidelines. Analyze routine claims that cannot be auto adjudicated. Complete eligibility verification and identify discrepancies in order to assist with adjudication. Coordinate responses for routine… Show more Claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. Review and adjudicate routine claims in accordance with claim processing guidelines. Analyze routine claims that cannot be auto adjudicated. Complete eligibility verification and identify discrepancies in order to assist with adjudication. Coordinate responses for routine phone inquiries and written correspondence related to claim processing issues. Route and triage complex claims to Senior Claim Benefits Specialist; proof claims or referral submissions to determine, review or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements. Utilize all applicable system functions available ensuring accurate and timely claim processing service. Show less



Hill Orthopaedics

• Orlando, Florida Area

• Office Manager

  • Dec 2003 - Dec 2006

  Office Manager for a high volume orthopedic practice with two sites, . Physician affiliated with two hospitals with high on-call and referral base. Management of staff, reviews of staff, initiate disciplinary procedures, monthly reports to physician, payroll, advertise and interview for positions available, direct monthly office meetings, follow up on physician and staff credentialing, licensing, put in place all HIPPA and OSHA regulations, schedule all necessary certifications for the staff… Show more Office Manager for a high volume orthopedic practice with two sites, . Physician affiliated with two hospitals with high on-call and referral base. Management of staff, reviews of staff, initiate disciplinary procedures, monthly reports to physician, payroll, advertise and interview for positions available, direct monthly office meetings, follow up on physician and staff credentialing, licensing, put in place all HIPPA and OSHA regulations, schedule all necessary certifications for the staff and myself, manage staff health and workers compensation insurances, management of building, equipment including inspections and repairs, accounts payable, accounts receivable, answering phones, making, auths appointments, surgeries and DME, verification of insurance, coding for surgeries and self pay patients, research MDs needed for referrals, marketing, purchase office supplies (clerical and non-medical), file dictations (electronic), deliver op reports to hospitals, in charge of all workers comp, hospital, physician and attorney cases, scheduling for functional medical examinations, stat diagnostic testing and surgeries, dealt with all correspondence to patients, adjustors, participating physicians, diagnostic medical necessity letters and referrals, review and approve all other purchases necessary for offices including medical, manage phone system and practice management software, liaison to the IT personnel, attend meetings as directed by the physician, coordinate with local technical institutions for student technician externs, coordinate schedule for depositions and luncheons, process all attorney correspondence, carry out all PCP referrals and consultation letters, door to door marketing to local physicians, attend health fairs, translator to Spanish speaking patients, see to deposits and banking business, and ready to take over an open position due to sickness, termination or any reason that may occur. Show less Office Manager for a high volume orthopedic practice with two sites, . Physician affiliated with two hospitals with high on-call and referral base. Management of staff, reviews of staff, initiate disciplinary procedures, monthly reports to physician, payroll, advertise and interview for positions available, direct monthly office meetings, follow up on physician and staff credentialing, licensing, put in place all HIPPA and OSHA regulations, schedule all necessary certifications for the staff… Show more Office Manager for a high volume orthopedic practice with two sites, . Physician affiliated with two hospitals with high on-call and referral base. Management of staff, reviews of staff, initiate disciplinary procedures, monthly reports to physician, payroll, advertise and interview for positions available, direct monthly office meetings, follow up on physician and staff credentialing, licensing, put in place all HIPPA and OSHA regulations, schedule all necessary certifications for the staff and myself, manage staff health and workers compensation insurances, management of building, equipment including inspections and repairs, accounts payable, accounts receivable, answering phones, making, auths appointments, surgeries and DME, verification of insurance, coding for surgeries and self pay patients, research MDs needed for referrals, marketing, purchase office supplies (clerical and non-medical), file dictations (electronic), deliver op reports to hospitals, in charge of all workers comp, hospital, physician and attorney cases, scheduling for functional medical examinations, stat diagnostic testing and surgeries, dealt with all correspondence to patients, adjustors, participating physicians, diagnostic medical necessity letters and referrals, review and approve all other purchases necessary for offices including medical, manage phone system and practice management software, liaison to the IT personnel, attend meetings as directed by the physician, coordinate with local technical institutions for student technician externs, coordinate schedule for depositions and luncheons, process all attorney correspondence, carry out all PCP referrals and consultation letters, door to door marketing to local physicians, attend health fairs, translator to Spanish speaking patients, see to deposits and banking business, and ready to take over an open position due to sickness, termination or any reason that may occur. Show less