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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Professional Summary

Pharmacy reimbursement specialist with specialty pharmacy and field-based consulting experience, including two years of people management. Excels at solving problems under pressure and keeping the focus on the patient.

Licenses

Certified Pharmacy Technician

State of Illinois License No. 049.192154

Skill Highlights
  • Knowledge of Medicare, Medicaid, and commercial benefits
  • Prior authorization and appeals expertise
  • Pharmacy claims
  • Superior customer service skills
  • Collaboration and communication
  • People- and patient-oriented

    Professional Experience
    Field Reimbursement Manager, 10/2014 to 09/2015
    CovanceEwing, NJ,

    In targeted accounts, worked with key office personnel to obtain coverage for client products. Assisted with submitting prior authorizations, working through peer-to-peer reviews and appeals, and educating on proper billing and coding procedures.

    Communicate daily with client sales staff and management as well as product benefit verification hub to coordinate unified and efficient outreach to target accounts.

    Trained peers on managing the multiple electronic tools that are utilized for reporting and account management.

    Leveraged knowledge of payer processes and requirements to obtain authorization approval in 87% of cases worked in 2015.

    Supervisor, Reimbursement Services, 09/2012 to 09/2014
    Argo AiMiami, FL,

    Managed 10-15 direct reports, including contract staff. Metrics based on call and case monitoring accuracy, service quality, and compliance.

    Held 1:1 meetings timely with all employees and led team meetings monthly. Organized team building activities and meals quarterly.

    Chosen as a member of the Pharmacy Solutions Continuous Improvement Initiative. The initiative developed a program to elicit ideas from staff for ways to improve quality, compliance, or productivity, and then reward those ideas.

    Primary liaison with HR and contract agency to communicate hiring needs and conduct interviews. Efforts led to the hiring of over 20 new personnel for the department.

    Insurance Analyst, 08/2010 to 09/2012
    AbbVie Pharmacy SolutionsCity, STATE,

    Verified insurance benefits for specialty medications and communicate coverage to patients and physicians.

    Built knowledge of a variety of insurance payers including commercial major medical plans and pharmacy benefit managers, buy and bill coverage, Medicare Part D and Medicaid.

    Due to high level of accuracy and detail-orientation in everyday work, tasked with updating reimbursement work instructions to be complete, accurate, and compliant.

    Identified as a side-by-side coach and trainer for new hires, to share best practices of efficiency and customer service excellence.

    Benefits Investigation Specialist, 01/2010 to 08/2010
    Caremark, Inc (Medix Staffing Solutions)City, STATE,

    Verified insurance coverage for multiple specialty medications and communicated benefits to patients and physician offices by phone.

    Used strong multi-tasking skills to exceed weekly productivity goals and close volume of cases in top 5% of the department.

    Regularly participated in overtime work as required to maintain customer focus.

    Skills

    pharmacy benefits, prior authorization, customer service, leadership

    Community Service

    Seasons Hospice - Direct Patient Care Volunteer

    In 2009, began volunteering by visiting patients in hospice care biweekly to chat, eat lunch, or go for a walk.

    In 2010, became certified as a vigil volunteer and have exclusively taken vigil assignments since.

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    Resume Overview

    School Attended

      Job Titles Held:

      • Field Reimbursement Manager
      • Supervisor, Reimbursement Services
      • Insurance Analyst
      • Benefits Investigation Specialist

      Degrees

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