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Team Lead/Patient Care Coordinator Resume Example

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TEAM LEAD/PATIENT CARE COORDINATOR
Summary

Seeking a challenging leadership role with an innovative organization, where I can utilize my 10+ years of experience as a health services professional in the pharmacy and medical office environment.

High-energy individual prepared to bring leadership skills and reimbursement knowledge developed over 10-year career and take on challenging new role at Trialcard. Proficient in conducting inspections, monitoring machinery and promoting efficient production. Clear communicator with decisive and well-organized nature.

Skills
  • Skilled in all aspects of Microsoft Office Data entry and management
  • Proficient in Quick Path
  • Proficient in CPR+
  • Proficient in Centricity
  • Proficient in Next-gen
  • Benefits
  • Coaching
  • Computer training
  • CPR
  • Client
  • Clients
  • Data entry
  • Financial
  • Gastroenterology
  • Insurance
  • Leadership
  • Leadership skills
  • Medical billing
  • Mentoring
  • Access
  • Microsoft Office
  • Next
  • Oncology
  • Patient advocate
  • Policies
  • Presentations
  • Processes
  • Quick
  • Surgery
  • Therapy
  • Training manuals
  • Vision
Experience
TrialCard Inc | Morrisville, NCTeam Lead/Patient Care Coordinator07/2019 - Current
  • Displayed positive leadership skills with department employees by coaching, mentoring and communicating client goals.
  • Trained employees on current practices and deadlines, while embracing the mission, vision and core values of TrialCard.
  • Ensured operational task are completed by developing schedules assigning and monitoring work, gathering resources and implementation productivity and ensuring performance goals are being achieved.
  • Collaborate with internal leadership to review and discuss process issues, identify primary risk and development contingency plans to proactively manage risk.
  • Served as a patient advocate by educating patients on financial aspects of healthcare services for the prescribed treatment.
  • Conducted medical benefits investigations, initiated and followed up on prior authorization and appeals request.
  • Escalated issues to the client to prevent the programs course from being in jeopardy and not delivering to contracted standards.
  • Serve as an advocate to patients and healthcare professionals regarding insurance coverage, medical billing, reimbursement process, and other general access issues like: Pharmacy Prescription Triage, Buy and Bill and Medical Benefit verification for complex pharmaceuticals.
    •Evaluate program enrollment forms for data integrity, and coordinate data processing.
    •Assist with insurance benefit investigations, and triage cases according to program standard operating procedures while ensuring accurate collection and reporting of information for related benefit fields.
    •Coordinate financial options for those with financial need as outlined by the SOP's.
    •Establish relationships, develop trust, and maintain rapport with patients and healthcare providers with a sense of urgency.
    •Follow program guidelines and escalate complex cases according to program policy and procedures.
    •Make additional calls as directed and be available to support patients, caregivers and other health care professionals by phone.
TrialCard Inc | Morrisville, NCReimbursement Case Manager/Field Support Liaison04/2018 - 07/2019
  • Manage the financial aspects of health care services to ensure patients have access to life saving treatments and prescribed therapy by conducting medical and pharmacy benefits investigations, prior authorizations and appeals support and initiate financial assistance.
  • Served as an advocate to patients and health care professionals regarding the reimbursement process and finding alternatives to reimbursement issues.
  • Coordinated with the Program manager regarding therapy access restrictions, policy changes in the reimbursement process.
  • Liaison between field reimbursement and client contacts to resolve program specific escalations, conflicts and/or questions.
  • Reported Adverse Events and Product Complaints via Rapid Rebate.
McKesson Specialty Health/Biologics, INC | Cary, NCReimbursement Specialist II09/2014 - 04/2018
  • Prepared and submitted claims through Medicare Part B, Medicare Part D, Medicaid, commercial plans and investigate claim rejections to determine drug cost of oncology medications.
  • A liaison to patients' healthcare professionals and pharmaceutical companies regarding insurance coverage, medical billing, and reimbursement processes.
  • Managed inbound calls on the insurance line from patients, clients, physicians and clinics regarding provided oncology services.
  • Utilized all resources to obtain insurance benefit coverage; including insurance overrides.
  • Assisted with training of new hires by creating training manuals, explaining job duties, company policies and extensive computer training.
  • Resolved patient and physician's complaints regarding insurance benefits, medication cost and shipment delays.
  • Submitted Prior Authorizations to insurance for denied claims.
Physicians East, P.A | Greenville, NCLead Patient Account Representative07/2005 - 09/2014
  • Managed Oncology, Gastroenterology, and Surgery Patients scheduled accounts.
  • Verified patient's insurance eligibility, reviewed claims and disputed denials with payers.
  • Placed outgoing and received incoming calls to address patients account balances and insurance questions.
  • Communicated face to face with patients regarding balances, collected payments and applied them to patient balances, set up financial agreements based on cost estimates for surgical procedures.
  • Conducted weekly bariatric classes for potential candidates which consisted of slide presentations and question and answer segments regarding surgery.
  • Coached and mentored new hires, created training manuals and provided detailed information on company goals and job specific requirements.
Education and Training
The University of Mount Olive | Washington, NCBachelors in Business Management2015
Additional Information
  • AWARDS , McKesson Specialty Health/ Biologics, Inc. Living our Pillars, December 2016 Recognition Award for outstanding work ethics, customer service skills, and going beyond for patients, clients and teammates. TrialCard Certificate of Recognition for outstanding achievement overall 100% quality score November 2019 Professional Development TrialCard Women's Development 2019 Volunteer Ronald McDonald House 2019
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Resume Overview

Companies Worked For:

  • TrialCard Inc
  • McKesson Specialty Health/Biologics, INC
  • Physicians East, P.A

School Attended

  • The University of Mount Olive

Job Titles Held:

  • Team Lead/Patient Care Coordinator
  • Reimbursement Case Manager/Field Support Liaison
  • Reimbursement Specialist II
  • Lead Patient Account Representative

Degrees

  • Bachelors in Business Management

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