Proven and effective field reimbursement manager with over 20 years of direct reimbursement experience in both private and public sector with an emphasis on Immunology, Oncology and Hematology. This includes Hub Management, Provider Education, Market Access and PAP Support program to ensure that patients have access to critical therapy navigating through a complex journey. Skilled at managing multiple diverse teams within the Healthcare Revenue Cycle Management Industry and with the ability to cover large areas. Proven success in balancing the operational demands of small, medium, and large business operations while exceeding client's expectations. I am a dedicated individual eager to use my extensive skills in Reimbursement Management to help your company meet its goals. Talented Sr Project Coordinator brings proven abilities in end-to-end project management. Expert in identifying and mitigating risks, reaching milestones and managing deliverables. Highly organized leader with great attention to detail.
- ICD-10 and HIPAA 5010
- Buy and Bill Process
- Methodology implementation
- Data Analysis
- Immunology, Oncology & Hematology
- Medicare Part A, B, C, D and Commercial Payer
- Hub Management and Collaboration
- Product launch expansion
- TECHNICAL SKILLS
- Microsoft Office
- Veeva
- SAP
- Concur
- Onco EMR
- Intergy
- Workday
- Complex Problem Solving
- Verbal and Written Communication
- Detail Oriented
- Work Planning and Prioritization
- Stakeholder Relations
- Resource Allocation
- Documentation and Reporting
- Team Collaboration
- Staff Management
- Team Leadership
- Performance Monitoring
- Quality Assurance
- Meeting Coordination
- Status Updates
- Presentation Abilities
Certified Revenue Cycle Analyst (HFMA)
Prior Authorization Certified Specialist (NBPAS)
Boston, MA, 01/2021 - Current
- Manage project per the Scope of Work (SOW) and within the contracted budget
- Ensure project is conducted according to UBC and Sponsor Standard Operating Procedures (SOPs)
- Serve as one point of contact with Sponsor(s) and internal employee project team
- Prepare or coordinate with an internal multidisciplinary team to develop deliverables
- Participate in internal project and client meetings
- Present information at client meetings and internal project review meetings
- Track and communicate delivery and/or completion of project deliverables to monitor revenue recognition, invoicing, and follow-up
- Contribute to operational aspects of the design, content, and preparation of protocols, amendments, project plans, and timelines
- Monitoring of study deliverables
- Participating in study planning and set-up activities including vendor management, project management, and coordination of study and implementation plans
- Supporting vendor relationships
- Using relevant reports, identify the progress of data collection and reporting
- Other duties as assigned
- Kept project and team on schedule by monitoring deadlines, milestones and performance.
Denver, CO, 01/2019 - 03/2020
- In targeted accounts; Establish relationships within a practice by working closely with them in overcoming payer access and reimbursement issues
- Handle escalated reimbursement issues related to prior authorizations and appeals
- Educate providers on product fulfillment pathways, including buy and bill retail pharmacy options
- Liaising with reimbursement hotlines (HUB Services) regarding alternative funding/financial assistance programs
- Educate HCP personnel on Patient access, provide guidance to HCP regarding payer coverage
- Educate physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs
- Track progress of patient cases and monitor coverage status; provide specific provider reimbursement support
- Effective utilization of data and analytical dashboard
- Liaised with nurse navigators and practice administration to obtain the information necessary to review treatment plan and monitor self-administration of medication, increasing reimbursement revenue by over 60
City, STATE, 04/2018 - 12/2018
- Oversaw daily workflow within the Billing Department
- Managed timely and accurate submissions of daily claims
- Ensured that the team maintained a daily focus on productivity and quality standards
- Managed application of payments, denials, rebilling, and maintaining daily and monthly collection reports
- Posted daily cash log and lockbox payments
- Prepared and posted office mail deposits
- Reviewed and validated all refund requests and forwarded to Office Administrator for processing
- Ensured the timely performance of follow-up activities with patients and/or physicians
- Reviewed and audited staff work, and any daily issues that may arise
- Insurance provisions and regulations
- Hired, coached, counseled and provided performance evaluations of team members.
City, STATE, 11/2002 - 04/2018
- Daily and monthly charge billing utilizing CPT and ICD10 codes according to applicable guidelines
- Worked closely with physicians, nurses and laboratory personnel to ensure that charges were captured accurately
- Correction of the edited report for transmitting clean claims via clearinghouse
- Monitored delinquent accounts and manage collection activities
- Evaluated denials and partial payments to determine if further reimbursement was valid
- Resubmitted corrected claims to include written appeals, to complete the billing process and ensure clean claims and maximum reimbursement
- Performed billing and payment data analysis, reconciled and audited assigned insurance and patient accounts to determine insurance payments have been received per contract
- Review unapplied cash reports for application, allocate payments.
- Consistently maintained high customer satisfaction ratings.
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School Attended
- Capella University
Job Titles Held:
- Sr Project Coordinator
- FIELD REIMBURSEMENT MANAGER
- BILLING DEPARTMENT MANAGER
- MEDICARE SPECIALIST/REVENUE CYCLE ANALYST
Degrees
- Bachelor of Applied Science
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