Therapy Access Manager Resume Example

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(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
  • Disease specialization proficiency Healthcare billing proficiency
  • Oncology, Immunology, Endocrinology, Hematology and Transplant Reimbursement Support
  • Medicare Part A, B,C, D and Commercial payer knowledge
  • Hub Management and collaboration on reimbursement level
  • Self-motivated
  • Claims investigation and research
  • Billing and coding
  • Conflict resolution techniques
  • Project organization
  • In-depth pharmacy law knowledge
  • Strong written and verbal communication skills
  • Works well independently
  • Effective at multi-tasking
  • Understanding of miscellaneous J-Code and Q code billing
  • Buy and Bill experience in all healthcare settings
  • Operations support
  • Team management
Professional Summary

Top-performing field reimbursement consultant with over a proven record of achievement and success in driving multi-million dollar growth in bio-pharmaceutical and oncology, endocrinology, hematology and immunology sector. Specialized in working with commercial and government payer reimbursement, heath reimbursement law, claim denial management and patient access. Excel in the development and maintenance of complex, client driven reimbursement programs in highly competitive markets.

Work History
Covance - Therapy Access Manager
Kalamazoo, MI, 11/2020 - Current

Primary responsibilities include the following.

• Equip HCPs and their staff, through education, to navigate the access and payer approval process.

  • Identify access barriers that the HCP must act to overcome, and highlight HCP actions that support access to therapy.
  • Develop and execute an education plan consisting of prioritized activities to best educate the HCPs in territory
  • Monitor, analyze, and triage situations which may adversely impact patient access to therapy.
  • Collaborate with entire Market Access department, other internal groups including sales, and medical groups, and HCPs to identify and resolve trending issues regarding patient access to therapies.
  • Educate HCPs regarding the access and payer approval process for Actelion therapies
  • Serve as subject matter expert for internal stakeholders and external HCPs regarding education on Medicare treatment guidelines, Medicaid Managed Care, commercial plans, PBM designs, policy changes, formulary status and the impact of healthcare reform on PAH coverage.
  • Maintain and share relevant information regarding account contacts, prior authorization requirements, trends, competitive intelligence, etc. with the Market Access Department.
  • Educate peers in the Customer Care Area about various elements of Market Access, including reimbursement, medical coverage policies and medical versus pharmacy benefit designs.
  • Execute business in accordance with the highest ethical, legal, and compliance standards, including timely and successful completion of all required training
Xcenda - Field Reimbursement Manager
City, STATE, 10/2017 - 01/2020
  • Interacted with key stake holders within specialty practice or hospital outpatient locations facilitating live training and education (group sizes vary)
  • Reviewing patient insurance benefit options. Validating prior authorization requirements identifying alternate funding/financial assistance programs
  • Reviewed appropriate billing and coding for products. Assisting with resolving reimbursement issues
  • Educated physician office staff on use of 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
  • Oncology, Hematology,Endocrinology , Immunology reimbursement support
  • Buy and Bill and Specialty Pharmacy Support to HCP
  • Adhere to ROE and SOP along with Compliance Standards
  • · Strong understanding of billing and coding and billing requirements at the local and national level
  • · Parts A, B, C and D or Medicare and associated reimbursement understanding
  • Managed eleven states on a six week rotation
  • Detailed orientated, use 30-60-90 day plan to stay organize and on target
  • Cross functional collaboration with multiple channels
  • Product Launch Support, subject matter expert
  • Patient centric and service oriented
  • Organizational skills managing expenses and company allotted budget sets
  • Highly interpersonal, emotional and empathetic skill set
Aetna SSI - Senior Medical Review Team Lead/Operations Supervisor
City, STATE, 11/2015 - 10/2017
  • 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
  • Validated schematic designs working alongside hardware engineers
  • Verified data integrity and accuracy
  • Responded to customer requests via telephone and email
  • 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
  • Review and Conducted Medical Review on Life and Med-Sup Policies
  • Partnered with Legal for weekly DOI meetings and filings
  • Managed a multi complex division with a 5% margin of error
  • 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 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 workflow 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
  • Used classification manuals to gain additional knowledge of disease and diagnoses processes.
  • Reviewed charts and flagged incomplete or inaccurate information.
  • Oversaw a six month project to revamp filing system, improving department productivity by 45%.
  • Received and routed medical records.
  • Prepared mailings of information and documentation.
Novartis Pharmaceuticals, United BioSource Corporation - Senior Reimbursement Project Manager
City, STATE, 02/2013 - 10/2015
  • Served as first point of contact for internal clients, members during 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 liaison between patients and physicians to assist patients in understanding their treatment plans
  • Served as key point of contact for agents, physicians and case managers on impending and pending issues or concerns
  • Served as 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
  • Transplantation Reimbursement Support, Lung, Kidney, Heart Novartis
University of Memphis Memphis, TN Expected in 05/2020 Doctor Of Philosophy : Clinical Psychology - GPA :
Strayer University Washington, DC Expected in 04/2015 Master Of Arts : Public Health Education - GPA :
Lane College Jackson, TN, Expected in 2010 Bachelor of Arts : Mass Communication, English - GPA :

Member of Mass Communication Club Coursework in Public Relation, Television Production, Photography, Public Speaking.

  • PCM (Professional Crisis Management) trained
  • Certified Aetna Technical Brand Writer

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Resume Overview

School Attended
  • University of Memphis
  • Strayer University
  • Lane College
Job Titles Held:
  • Therapy Access Manager
  • Field Reimbursement Manager
  • Senior Medical Review Team Lead/Operations Supervisor
  • Senior Reimbursement Project Manager
  • Doctor Of Philosophy
  • Master Of Arts
  • Bachelor of Arts