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

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Links
  • https://www.linkedin.com/in/JessicaClaire
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 Associate Field Access & Reimbursement Manager that proactively manages account utilization management process. Excellent customer relations skills combined with analytical approach to handling routine and complex delays.

Skills
  • Case Management
  • Creating and facilitating training
  • Identifying process gaps and opportunities for improvement
  • Knowledge and understanding of pharmaceutical trade & distribution regulations
  • Strong written and verbal communication
  • Strategic planning
  • New account onboarding
  • Attention to Detail
  • Conflict resolution techniques
  • Strong critical thinking capabilities
  • Responsible handling of protected health information (PHI)
  • Patient and family advocacy
Work History
Trade Compliance Specialist | Field Access, 04/2017 - Current
Memorial Sloan-Kettering Cancer Center Commack, NY,
  • Manages over 15 in-network Specialty Pharmacy, Specialty Distributor, Wholesaler & 3PL Accounts 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.
  • 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.
  • Resolves day-to-day product inventory discrepancies, order issues, process deviations and field inquiries
Patient Care Technician, 08/2013 - 06/2017
St. Peter's Healthcare- 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, tracked 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.
Prior Authorization Coordinator | Ophthalmic Tech, 09/2015 - 04/2017
Ophthalmologist Office City, STATE,
  • Led team of four technicians supporting two physicians in a fast-paced, high-volume office setting (40-50 patients daily).
  • Served as first assist to physicians during in-office procedures.
  • 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.
Associate Customer Service Manager, 06/2009 - 01/2013
A&P Food 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.
Education
Certificate: Professional Medical Billing, Expected in 08/2022
-
AAPC - Remote,
GPA:
Status -
  • Continuing education in Certified Professional Billing (CPB)
  • 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
Bachelor of Arts: Biology, Expected in 05/2015
-
University At Albany - Albany, NY,
GPA:
Status -

Coursework included: Pathophysiology, Microbiology, Anatomy & Physiology, Pharmacology, Medical Anthropology

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Resume Overview

School Attended

  • AAPC
  • University At Albany

Job Titles Held:

  • Trade Compliance Specialist | Field Access
  • Patient Care Technician
  • Prior Authorization Coordinator | Ophthalmic Tech
  • Associate Customer Service Manager

Degrees

  • Certificate
  • Bachelor of Arts

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