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Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Professional Summary
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 University Washington, DC Expected 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-- 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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resume Strength

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Resume Overview

School Attended

  • Howard University

Job Titles Held:

  • Field Reimbursement Manager
  • Health Reimbursement Law Analyst
  • Program Specialist/Trainer

Degrees

  • Bachelor of Arts

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