Top-performing, experienced field reimbursement consultant, with a proven record of achievement and success in driving multimillion-dollar growth in bio-pharmaceutical sector. Specialized in working with commercial and government payer reimbursement, health reimbursement law, claim denial management, and patient access to bio-pharmaceuticals on the market. Excel in the development and maintenance of complex, client-driven reimbursement programs in highly competitive markets.
Skills
Motivated self-starter
HIPAA regulations and compliance
Insurance billing
Strong presentation skills
Patient-focused reimbursement support
ICD-9/ICD-10 (International Classification of Disease Systems)
HCPCS and CPT coding guidelines
Familiar with commercial and managed care insurance carriers
Education
Howard UniversityWashington, DCExpected in 2006 – –Bachelor of Arts:Journalism - GPA:
Work History
Covance - Field Reimbursement Manager Madison, WI, 2012 - Current
Advise and assist healthcare entities in overcoming payer access and reimbursement issues in order to maximize patient access to FDA-approved pharmaceuticals.
Educate providers on product fulfillment pathways, including physician buy and bill, retail pharmacy and specialty pharmacy options.
Develop market access and pricing proposals to assist with negotiation of drug pricing.
Specialized reimbursement knowledge within the following disease states--Â rheumatology, oncology, mental health.
Deliver professional speaker programs detailing trends in healthcare, medical billing and coding practices, and practice management administration in physician office and hospital settings.
Partner with reimbursement matrix team and third-party reimbursement support program to assist health care providers within the following reimbursement and access areas--copay assistance programs, prior authorization support, claims denial management and tracking, health benefit verification and clinical policy education.
Fotheringill & Wade, LLC - Health Reimbursement Law Analyst City, STATE, 06/2011 - 01/2012
Primary third party point-of-contact, assisting 5 regional hospitals in the financial management of medical claims throughout the medical billing revenue cycle, utilizing health law mandates and guidelines governing health insurance.
Drafted medical appeals, in order to reverse claim denials on behalf of acute inpatient sites of care. Insured prompt payment of denied and underpaid health insurance claims, resulting in excess of $200,000 monthly revenue.
Draft legal memoranda relating to the Employee Retirement Income Security Act (ERISA), Code of Maryland Regulations (COMAR) and Health Services Cost Review Commission (HSCRC) hospital reimbursement rates for the state of Maryland and surrounding regions.
Mastered the use of two commonly utilized provider management software (MediTech and MediSoft) to perform claim issue resolution, and confirm payment of claim denials overturned during the administrative and clinical appeal process.
Compiled and analyzed denial management reports to review productivity and financial analysis of incoming denials and subsequent reversals of denials.
Covance Market Access - Program Specialist/Trainer City, STATE, 07/2009 - 06/2011
Reimbursement support specialist, ensuring patient access to biopharmaceuticals in the area of Rheumatology.
Provide mentoring and product training to staff, both program specific and company-wide.
Spearheaded reimbursement support team during 4-month reimbursement support project; mentored and coached 60 staff members; performed data quality audits; developed process flow, detailing insurance benefit investigation protocol.
Benefit investigation project generated over $1 million in revenue.
Determined the eligibility of over 300 patients in two multi-million dollar copay assistance programs; identified eligibility criteria for over 100 patients in three alternate funding programs.
Provide E-service training to providers requesting online access to benefit investigations, prior authorization support, specialty pharmacy research, and product information involving ICD-9, CPT and HCPCS coding.
Affiliations
American Association of Professional Coders, member
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