Customer service oriented, professional who provides timely and accurate data to ensure reimbursement for patient and provider services. Follows policies, procedures, and guidelines to assure consistent quality. Maintains and ensures patient privacy and confidentiality.
Skills
Strong written, verbal, and interpersonal skills for effective communication and documents
Well organized and experienced with Microsoft Word
Ability to work under pressure
Conflict resolution
Data Analysis
Integrity and ethics
Time management and efficiency
Extensive knowledge of commercial medical Insurance, Pharmacy Benefits, CPA Programs ETC.
Knowledge on Government funded Insurances (Medicare, Medicaid, TRICARE, ETC.)
Adaptability, capable of working in constant change in workplace
Work History
Care Coordinator, 02/2020 to Current Northern Arizona Healthcare – Camp Verde, AZ,
Administrator for internal website
Serve as an expert on reimbursement, co-pay, foundation assistance and PAP issues and be responsible for handling patient and healthcare provider interactions
Serves as direct point of contact to assigned health care providers for ongoing support and relationship
development by acquiring and delivering detailed information regarding a program and/or a patient
Partner with the prescriber and patient to remove all non-clinical barriers to patient access to prescribed
therapy
Knowledge and understanding of the different types of major payers including private/commercial and
government (Medicare, Medicaid, VA and DOD). Act as an assigned liaison to client contacts (e.g.
regional contact for sales representatives)
Maintains records in accordance with applicable standards and regulations to the programs/promotions
Establish relationships, develop trust, and maintain rapport with patients and healthcare providers
Follow program guidelines and escalate complex cases according to program policy and procedures
Liaison between Program Management, Healthcare Providers and Manufacturer
Provides unparalleled customer service while serving as a brand advocate and program representative;
understands the importance of achieving quality outcomes and commit to the appropriate use of
resources
Works with the Franchise Program Manager, and Client on a day-to-day
basis to maintain open lines of communication and share awareness regarding patient status, prescriber
feedback/satisfaction and program effectiveness
• Improve patient outcomes through advocacy, communication, education and facilitation of services
Understand health and disease states of patients of the programs/promotions
• Maintains a high level of ethical conduct regarding confidentiality and privacy
Conflict Resolution
Reimbursement Specialist, 11/2019 to 02/2020 Francisan Health – Tinley Park, IL,
Keep abreast of payer trends and policies.
Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD).
Working case management system, documenting status/background in case notes, communicating patient benefits, assisting in the PA process and like responsibilities.
Responsible for insurance benefit investigations, and triage cases according to program standard operating procedures.
Customer Service Representative, 01/2018 to 01/2019 Parker's Convenience Stores – Monck's Corner, SC,
Provided primary customer support to internal and external customers in fast-paced environment.
Performed data entry, managed heavy telephone work, and provided high quality customer service in a call center setting.
Offered advice and assistance to customers, paying attention to special needs or wants.
Answered customer telephone calls promptly to avoid on-hold wait times.
Responded to customer requests for products, services and company information.
Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Customer Service Representative, 11/2015 to 11/2016 Parker's Convenience Stores – Hardeeville, SC,
Performed data entry, managed heavy telephone work, and provided high quality customer service in a call center setting.
Acted as the direct point of contact for customers.
Maintained a high level of confidentiality while accessing customer accounts.
Effectively communicated all information with customers.
Brought finely tuned attention to detail and commitment to quality to all assigned tasks.
Serve as a resource for patients and healthcare professionals to verify insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals.
Evaluate program enrollment forms for data integrity.
Ability to understand and explain benefits offered by all payer types including private/commercial and government (i.e., Medicare, Medicaid, VA and DOD).
Keep abreast of payer trends and policies.
Follow program guidelines and escalate complex cases according to program policy and procedures.
Education
Associate of Science/Health Sciences Degree: Health Sciences, Expected in 10/2018 Ultimate Medical Academy - Clearwater, FL, GPA:
Fully accredited, accelerated program providing instruction in medical administrative and general office procedures, transcription, medical records management and reimbursement methodologies including revenue cycle management. Program content emphasizes medical billing procedures, basic procedural and diagnostic coding systems, collections procedures and accounting functions essential to the medical environment. Research, professional writing, critical thinking and communications skills are developed throughout the program.
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