Top performing, experience insurance analyst, with a proven track record of achievement and success. Specialized in working with commercial and government payer reimbursement, health reimbursement law, claim denials, and patient access to specialty medication and bio-pharmaceuticals on the market.
Motivated self starter
HIPAA regulations and compliance
Strong presentation skills
Patient- focuses reimbursement support
ICD-9/ICD-10 (International Classification of Disease Systems)
HCPCS and CPT coding guidelines
Familiar with commercial and managed care insurance carriers.
AbbvieOctober 2013 to CurrentInsurance Analyst North Chicago, IL
Lead project to create new benefit summary template to show improved legibility and readability for patients and doctors.
Improved and streamlined insurance payer information throughout the department with Microsoft Excel on a yearly basis.
Spearheaded and updated prior authorization library on a quarterly basis to remain complaint across all pharmacy areas.
Created pricing calculation tool for greater accuracy of patient's financial responsibility within the different phases of their Medicare prescription drug plan.
Lead training and presented to entire department, including upper management, on overall process improvement updates and daily metrics reports.
CVS/CaremarkApril 2013 to October 2013Benefits Investigative Specialist Buffalo Grove, IL
Organized and prepared various medical documents and reports for physicians and insurance companies to initiate prior authorizations for specialty medications.
Received 100% case and call monitoring scores while managing approximately 40 cases per day.
Specialized reimbursement knowledge with multiple disease states-rheumatology, dermatology, and gastroenterology.
Inform providers of product fulfillment pathways, including physician buy and bill, retail pharmacy and specialty pharmacy options.
Verified patient benefits through the use of multiple eligibility web tools including Emdeon, Ecare, and Avaliaty.
Athletico Physical TherapyJanuary 2012 to April 2013Rehabilitation Aide Des Plaines, IL
Communicated directly with doctors' offices via telephone, fax and email.
Verified patient data and billing information.
Regularly completed paperwork and entered prescription and insurance billing information into patient profiles.
Maximized employee retention by creating positive work environment.
University of Illinois - Chicago2011Bachelor of Science: Applied Heath Science - KinesiologyChicago, IL