Experience

AIS Healthcare

• United States
• Pharmaceutical Manufacturing
• 100 - 200 Employee

• Financil Client Concierge Advisor

  • Dec 2019 - Present

  First point of contact for the Regional Sales Manager (RSM’s) to ensure all client concerns and issues are addressed/resolved. Proactively process overrides for client orders Address all client questions when billing policy changes. Take escalation calls from clients , patients, and regional sales managers. Conducts follow-up phone calls to clients as needed; recognizes and resolves customer issues in a timely manner. Serves as an initial and consistent point of contact for RSM’s regarding financial assistance program regarding statements, insurance changes, billing issues and charges. Manages, updates, and communicates all aspects of the FAP to appropriate party. Communicates and obtains any requested patient/ client information changes for database maintenance/updates. Performs other job related duties as assigned. Work with internal partners on strategic initiatives for plan/member optimization. Interprets plan rules to ensure compliance with plan documents and summary plan.



Option Care

• United States
• Transportation, Logistics, Supply Chain and Storage

• Intake Coordinator

  • Feb 2016 - Dec 2019

  Verify patient eligibility, coordinate benefits, run test claims and determine patient coverage/responsibility for services and testing and implementation of both pharmacy and major medical plan business. Performs Insurance Verification of benefit coverage on all of patient's insurance plans for each service being provided. Obtains and documents in the system all information related to coinsurance, copay, deductibles, authorization requirements, etc. 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 initial authorization prior to admitting the patient for all services for any insurance plan that has authorization requirements. Obtains reauthorization as necessary, reviews physician orders from pharmacy to determine if authorization is required on changes / additions to therapy for patients that are already on service. Obtain and input initial demographics for inpatient and outpatient pre-certification. Accurate documentation of information obtained. Screen calls appropriately and work with clinicians to ensure optimal turnaround times. Responsible for completing callbacks in an efficient manner. Print, correct and forward reports requested to nurses or supervisor. Responsible for managing all clinical faxes and ensuring all regulatory timelines are met. Identification of any errors within multiple systems utilized and forward to supervisor as indicated. Responsible for meet all regulatory and compliance requirements for Utilization Management.



Express Scripts

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

• Express Scripts/ Medicare Account Manager

  • Oct 2005 - Nov 2015

  Reviewed and updated Medicare enrollment related requests. Reviewed, tracked, and updated Complaint Track Module from Medicare and grievance cases within required turnaround timeframes. Provided analytics on grievances cases for root cause review. Analyzed data from call audits, internal tracking systems, customer feedback surveys, and employee feedback, isolating quality deficiencies in a complete, accurate and timely manner. Supported implementation team by providing input to development of configuration process. Assisted with developed functional specifications for clients’ business requirements and Centers for Medicare / Medicaid Services (CMS) regulations. Managed audits, mock audits, and executed necessary corrective action plan and training. Investigated, identified and developed policies and procedures, ensuring adequate internal controls and compliance with legal and contractual requirements. Developed and implemented projects that affected Express Scripts operational policy.



American Airlines

• United States
• Airlines and Aviation
• 700 & Above Employee

• Homebase Representative

  • Jun 2013 - Apr 2014

  Handled customer inquiries, complaints, billing questions, schedules, fares and flight information to customers in a manner that met standards of high customer service as outlined in training and call handling guidelines. Managed high-volume workload within a deadline-driven environment, resolving average of 550 inquiries weekly and consistently meeting performance benchmarks in all areas. Helped company attain highest customer service rating (as determined by external auditors), earning 100% marks in all categories including communication skills, listening skills, problem resolution, and politeness.