Oncology, Endocrinology, Hematology experienced Field Reimbursement Manager with over 8 years of experience in reimbursement support of speciality injectable medications. Excellent reputation for resolving problems, improving customer satisfaction, and driving overall operational improvements.
Oncology, Immunology, Endocrinology, Hematology and Transplant Reimbursement Support
Medicare Part A, B,C, D and Commercial payer knowledge
Speciality Pharmacy process and provider support
Hub Management and collaboration on reimbursement level
Self-motivated
Process implementation
Team liaison
Project manager supervision
Claims investigation and research
Speciality Pharmacy Billing
Project management
Effective communication skill
Relationship building
Stakeholder relations
Client account management
In-depth pharmacy law knowledge
Chronic disease management
Strong written and verbal communication skills
Works well independently
Effective at multi-tasking
Budget administration
Team building skills
Understanding of miscellaneous J-Code and Q code billing
Buy and Bill experience in all healthcare settings
Territory Management (Multiple State Coverage on six week rotation)
Self Starter, seeker of solutions and answers
Culture focused and dedicatoin
Work History
Field Reimbursement Manager , 10/2017 - Current Covance – Cleveland, OH,
Interacting with key stake holders within the specialty practice or hospital outpatient locations facilitating live training and education (group sizes vary)
5+ years of experience with specialty providers in support of reimbursement
Reviewing appropriate billing and coding for products. Assisting with resolving reimbursement issues
Coordinating with client’s patient support services programs representatives
Educating physician office staff on the use of the client’s patient assistance and reimbursement support services including web based provider programs. Providing information on relevant reimbursement topics related to client’s products
Collaborated with team to define business requirements for organizational processes, achieve productivity standards and adhere to accuracy standards
Implemented brand and demand strategies to meet revenue targets for business services and products
Operated with high integrity, built trust, and earned sustained credibility with internal and external clientele
Developed and executed targeted relationship and account development strategy
Interpreted and communicated new or revised policies to staff.
Work with Sales personnel and managed market accounts finding solutions to address coverage and reimbursement barriers
Oncology Account Manager
Assisted in managed market training and ROE (Rules of Engagement ) implementation.
Senior Medical Review Team Lead , 11/2015 - 10/2017 Aetna SSI – City, STATE,
First point of contact for Operation system issues for Medical Review Team
Provided detailed analyses of weekly and monthly team metric to Senior Leadership Team
Monitored and Audit team productivity at 100% Subject Matter Expert on making sure all team SOP are current and implemented
Entered details such as payments, account information and call logs into the computer system
Initiated two key partnerships which resulted in 54% revenue growth
Validated schematic designs working alongside hardware engineers
Verified data integrity and accuracy
Responded to customer requests via telephone and email
Analyzed departmental documents for appropriate distribution and filing
Copied, logged and scanned supporting documentation
Worked directly with Underwriting, New Business and Sales to achieve one call resolution
Evaluated quality problems and performed 100% audit to identify and resolve issues.
Identified and resolved process issues to encourage smoother procedures, more efficient workflow and overall business growth.
Supervised production planning while using appropriate tools and analysis for smooth production output.
Presented metric reporting and daily to Director on teams daily work load and time sensitive accounts.
Coordinated with Claims and New Business team in developing project plans for prioritized initiatives.
Developed standard operating procedures and document workflows for current and future process steps.
Developed team communications and information for weekly Monday team meetings.
Researched and compiled statistical data to support cost control and care improvement initiatives.
Kept accurate log of all requests for medical information and records.
Managed system conversion and maintained minimal downtime during updates.
Identified new methods to optimize medical records management.
Trained twenty direct reports on department procedures and policies to maximize department effectiveness.
Resolved conflicts and negotiated agreements between parties in order to reach win-win solutions to disagreements and clarify misunderstandings.
Senior Reimbursement Oncology Manager , 02/2013 - 10/2015 Novartis Pharmaceuticals, United BioSource Corporation – City, STATE,
Served as first point of contact for internal clients and members during the enrollment process
Make outbound calls to members to gather Enrollment Data; analyze and process data accordingly
Handle inbound member calls and written correspondence regarding member eligibility Solved complex or critical member/client issues
Worked collaboratively with Eligibility Systems Analysts, other Eligibility Associates, Eligibility Managers and Account Managers to provide seamless support
Identify and escalate repetitive questions and /or problems so that corrective action can be pursued and expedited
Provided seamless updates to Key Account Holders and Program Manager bi weekly via conference call on metrics, pending request and trends
Utilized strong assessment skills to determine necessary patient care
Served as a liaison between patients and physicians to assist patients in understanding their treatment plans
Served as a key point of contact for agents, physicians and case managers on impending and pending issues or concerns
Served as a Project Manager on new product launch for Signifor LAR and re-branding Transplant Team
Managed high-value existing and new business partnerships to deliver on objectives and maximize corporate revenue, support and awareness.
Presented metric reporting bi-weekly on account reviews to Senior Leadership team and clients.
Conducted training and change management processes to improve operations.
Created and managed knowledge base to offer staff and customers immediate informational access to products, services and organization.
Analyzed current business plan, identified inefficiencies in existing processes, and tracked performance following implementation of improvements.
Closely collaborated with project members to identify and quickly address problems.
Communicated project plans and progress to key stakeholders, including project contributors, business, operational and technical resources.
Developed project plans identifying key issues, approaches and performance metrics.
Managed project elements for multiple initiatives from initial planning to project rollouts.
MBA: Public Health, Expected in 04/2017 - Strayer University - Memphis, TN , GPA:
Bachelor of Arts: Mass Communication, English, Expected in 2010 - Lane College - Jackson, TN, GPA: Member of Mass Communication Club
Coursework in Public Relation, Television Production, Photography, Public Speaking.
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