trade compliance specialist field access reimbursement trainee resume example with 12+ years of experience

Jessica Claire
, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - - -
Professional Summary
RE: Field Reimbursement Manager, 06/16/2022 Dear Hiring Professional, With my robust customer service management experience, 5 years of experience working under and building relationships with healthcare providers and caring for patients directly, 5 years of specialty drug distribution experience and 2 years of Field Access & Reimbursement experience, my skills and qualifications are unique and an ideal match to the Field Reimbursement Manager requirements and will bring immediate value to any client of Xcenda. Patient access and advocacy became a personal passion project of mine in 2019, where I took the initiative to create a Field Access & Reimbursement Development Plan while working full time as a Trade Compliance Specialist at Regeneron Pharmaceuticals that become an example for those across the company seeking to transition to another area of the business. In this program, I've demonstrated excellent understanding of the buy and bill reimbursement pathway as well as pharmacy benefit prior authorization claims, appeals and denials. I am skilled in drug therapy management with proficiency in creating leave behind resources and training. I've received numerous endorsements from Access & Reimbursement Managers whose contact information I would be happy to share upon request. The value I can offer having trained under experienced Field Reimbursement Managers and pursuing a certification in Medical Billing will bring something to your team that you didn't realize was missing. I believe my collaborative approach to problem-solving and stellar customer service abilities will exceed your expectations for this role. To further understand the scope of my career history and professional competencies, please take a moment to review my attached resume. I appreciate your evaluation of my credentials and subsequent response. Sincerely, Jessica Claire PROFESSIONAL SUMMARY Former Prior Authorization Coordinator, now experienced in specialty biologic Trade Compliance, with solid background proactively submitting claims and preventing insurance issues. Simultaneously functions as both a Trade Compliance Specialist and Field Access & Reimbursement Manager trainee that proactively manages account utilization management process. Excellent customer relations skills combined with analytical approach to handling routine and complex delays.
  • Case Management
  • Medical Billing, CPT, ICD-10-CM, and HCPCS Level II coding
  • Creating and facilitating training
  • Identifying process gaps and opportunities for improvement
  • Strong written and verbal communication
  • Strategic planning and project management
  • New account onboarding
  • Strong attention to Detail
  • Complex Problem Solving
  • Strong critical thinking capabilities
  • Responsible handling of protected health information (PHI)
  • Patient and family advocacy
  • Created self-driven Access & Reimbursement training program which included ongoing one on-one mentorship by over 10 past or present Field Access or Field Reimbursement Managers at Regeneron Pharmaceuticals across multiple product franchises. This was done while simultaneously serving as a Trade Compliance Specialist at Regeneron and pursuing a Certification in Professional Billing through independent study. In this program, I gained extensive experience in buy and bill reimbursement, pharmacy benefit prior authorization, denials and appeals support and account management with recorded time in the field. References and/or endorsements can be provided upon request.
    Work History
    04/2017 to Current
    Trade Compliance Specialist | Field Access & Reimbursement Trainee Memorial Sloan-Kettering Cancer Center West Harrison, NY,
    • Manages over 15 accounts including in-network Specialty Pharmacy, Specialty Distributor, Wholesaler & 3PL partners to ensure there is no disruption in the commercial drug distribution process
    • Guides healthcare provider and their clinic ancillary staff through request process for buy and bill product returns
    • Manages cases and commits to a 24-48 hour turnaround for request completion
    • Serves as subject matter expert in matrix environments by working directly with internal and external auditing agencies to remedy distribution compliance issues
    • Directs and implements strategic improvement plans to integrate solutions to audit findings and workflow process issues representing a 400% increase in policies written and executed YOY
    • Develops and conducts trainings to verify employee compliance with established corporate and regulatory body policies and procedures
    • Uses problem solving techniques to resolve day-to-day product inventory discrepancies, order issues, process deviations and inquiries
    08/2013 to 06/2017
    Patient Care Technician St. Peter's Health Partners City, STATE,
    • Served as first assist to RN in providing hands on patient care in various institutional care settings e.g., Intensive Care, Cardiology, Medical/Surgical, Geriatric and Behavioral Health
    • Obtained patient vital signs and reported results on 16 patients to RN, noting changes from prior measurements
    • Monitored and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery
    • Responded to patient emergencies with immediate care and notified clinicians to provide comprehensive assistance
    • Performed inpatient and outpatient phlebotomy and specimen collection services
    • Organized and replenished unit supplies to maintain team readiness for expected admission demands.
    09/2014 to 04/2017
    Prior Authorization Coordinator | Ophthalmic Technician Mable MP Cheng City, STATE,
    • Led team of four technicians supporting two physicians in a fast-paced, high-volume office setting serving 40-50 patients daily
    • Performed vision benefits investigation, initiated prior authorization process to verify eligibility and compliance with payer utilization criteria
    • Created and maintained spreadsheets detailing medical procedures, diagnosis codes and insurance denials and approvals to be reviewed with physicians weekly
    • Obtained chief complaint, history of present illness and ocular vitals from patients to ensuring complete clinical documentation was available using proper medical terminology for physicians to determine proper course of treatment
    • Performed diagnostic testing and imaging including refraction, fundus photography, OCT, corneal topography, specular microscopy, fluorescein angiography to be submitted with insurance claims
    • Collaborated with medical sales representatives to ensure office received latest product offerings and technical support.
    06/2009 to 01/2013
    Associate Customer Service Manager & Bookkeeper A&P Grocery Store City, STATE,
    • Supervised team of 5-7 cashiers
    • Helped large volume of customers daily by solving pricing discrepancies with a positive attitude and focus on customer satisfaction proven by sharp increase in "excellent" customer satisfaction survey responses by 33% in one year
    • Offered advice and assistance to customers, paying attention to special needs or wants
    • Informed customers about special promotions and provided detailed information for various products
    • Posted daily receipts and payments in accordance with corporate protocols
    • Maintained and processed invoices, deposits, and money logs
    • Reconciled and corrected issues with financial records.
    Expected in AUGUST 2022
    - ,
    Expected in
    Certified Professional Biller:
    American Academy of Professional Coders - ,
    Expected in
    Remote IN PROGRESS:
    - ,
    Expected in
    Coursework includes but is not limited to: Understanding Health Insurance Models, Prior Authorizations/Denials/Appeals, Medical Necessity, Claim Forms (CMS-1500 and UB-04):
    - ,
    Government Carriers (Medicare, Medicaid, and TRICARE),Blue Cross/Blue Shield, Commercial Insurance Carriers
    Expected in
    B.A: Biology
    University at Albany - Albany, NY
    Expected in
    Coursework included: Pathophysiology, Microbiology, Anatomy & Physiology, Pharmacology, Medical Anthropology:
    - ,

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    Resume Overview

    School Attended

    • American Academy of Professional Coders
    • University at Albany

    Job Titles Held:

    • Trade Compliance Specialist | Field Access & Reimbursement Trainee
    • Patient Care Technician
    • Prior Authorization Coordinator | Ophthalmic Technician
    • Associate Customer Service Manager & Bookkeeper


    • Certified Professional Biller
    • Remote IN PROGRESS
    • Coursework includes but is not limited to: Understanding Health Insurance Models, Prior Authorizations/Denials/Appeals, Medical Necessity, Claim Forms (CMS-1500 and UB-04)
    • B.A
    • Coursework included: Pathophysiology, Microbiology, Anatomy & Physiology, Pharmacology, Medical Anthropology

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