Experience

Accredo - An Express Scripts Company

• Hospitals and Health Care
• 300 - 400 Employee

• Director of Strategic Planning

  • Sep 2018 - Present

• Chief Product Owner: IT Transformation

  • Dec 2016 - Present

  • Enabled $10M in yearly savings for Patient Access Department through use of Agile Technology Development• Identified vendor services that allowed for automation and reduced 75% of work content for function.• Two Machine Learning Patents Pending, implemented into processes to drive bad debt reduction and efficiency.• Combined use of multiple legacy systems and processes into “Single Process and Single Platform”.• Managed expectations, communication and relationships between multiple VPs and Sr. Directors.• Expanded use of Robotics to bridge the gap between legacy state and transformed system and save $750K/Yr.• Define the vision and scope for the Patient Access Department’s new application• Develop the product roadmap that supports Operations Area with 1K+ Users• Strategize with cross-functional team to create End to End processing system for Specialty Operations• Collaborate with operations to coordinate product releases and roll out to business• Work with functional/business leader, operational leaders, and technology leaders to mitigate issues and review areas for opportunities.• Develop, Monitor and Improve product performance metrics in collaboration with technology teams.• Define business KPI’s that are related to capabilities that are being performed by Accredo Clearance system• Leverage data to identify new opportunities for improvement

• Sr. Manager-Patient Access

  • Jul 2014 - Apr 2017

  Led team of 50 Sr. Prior Authorization Representatives and 3 Supervisors in Clearance functions to ensure payment of services provided to newly referred patients of Accredo.Create, revise and implement SOPs of Patient Access department in effort to standardize tasks, improve efficiencies and ensure contracts are followed.Collaborate with Pharmacy Operations, Physician Sales, Nursing, Manufacturers, Payors, Payor Account Managers and Billing and Reimbursement to ensure services are provided to patients timely and payment is secured.IT project lead for Patient Access- led team to develop and implement IT projects to enhance the performance of the Patient Access team. Worked directly with IT team in the development, testing and implementation phases of projects.

• Reimbursement Manager

  • Nov 2011 - Jul 2014

  • Responsible for management of $65M in accounts receivable –consistently meeting cash collections goals• Led project to update, standardize and facilitate training of Collections department for integration of multiple divisions to single reimbursement department• Subject Matter Expert on MedeAnalytics AR tool-participated in developing ideas for use of site and its reporting features for collections department• Create, Revise and Implement SOPs of collections department in effort to standardize tasks, improve cash collections and reduce bad debt• Collaborate with Clearance, Billing and Cash Departments in order to identify and address billing and payor issues

• Payor Relations Manager

  • Feb 2011 - Nov 2011

  Serve as a liaison between the National Sales Team, Pricing, Contracting and Managed Care to facilitate expeditious clearance of referrals while ensuring the utilization of strategies to maximize profit and minimize loss.Serve as liaison between Third Party Payors, Clearance and Reimbursement Units to resolve negotiation and/or claim issues for unique or high AR issues.

• Reimbursement Supervisor

  • Jun 2009 - Feb 2011

  • Ensure Reimbursement Specialists compliance to all billing rules and collection processes for $25 Million of Accounts Receivables• Coach employees on performance, provide support and motivation required to excel• Trend, report and resolve payor issues with provider relations liasons

• Lead Clearance Specialist

  • Jun 2008 - Jun 2009

  •Liaison: Serve as a link between the team and supervisor. Field team member questions. Report team’s contributions and work progress to supervisor.•Auditor: Audit team new referrals after clearance process, cods after completion and holds prior to removal.•Leader: Influence team members to perform to their abilities while contributing to the team. Lead by example while working assigned SCS tasks.

• Senior Clearance Specialist

  • Aug 2007 - Jun 2008

  •Insurance Verification: Contact insurance companies to verify benefits for new referrals and existing patients with insurance changes.•Prior Authorization: Liaison between prescribing physician and insurance companies to communicate medical necessity for the prescribed medication.•Shipment Completion: Ensure accurate data when processing invoices, including precise contract pricing and proper approvals within timely filing deadlines.

• Reimbursement Specialist

  • Sep 2006 - Aug 2007

  •Editing: Ensured invoice pricing is accurate and concise claims are billed to payors•Collecting: Pursued collection activities to ensure receivables are reimbursed accurately and timely•Billing: Responded to billing inquiries from the branch offices and insurance companies