| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Street Address
Phone: PHONE NUMBER AVAILABLEAlt Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEEmployment History06/2023-01/2024Program SpecialistThe Lab- Remote June 2023 to Jan 2024 Outbound calls to payers to obtain benefits Close current cases Obtain MI for insurance claim Calling payers for Medicare, Medicaid, other payers Faxing PA to providers Obtaining benefits for Data Check Placing cases in payer delay and following up daily Creating payer trend Using LCA forms for patients Using Salesforces systems Using CRM Using Teams Send emails Working from excel Using pivot Processing PA forms Verification of J-code Dx codes CPT codes Medical terminology04/2023 - 08/2023Reimbursement Field Case ManagerReimbursement Field Case Manager Aston Carter/Trial Card - Remote April 2023 to August 2023 Pharmaceutical Drug Company, Works with the Market Access Organization task helping HCP navigate reimbursement issues for the drug that FRM is supporting Attentiveness to detail Accuracy & possess organizational skills Coordination of resources with primary & secondary third-party payers Coding, coverage, & payment systems describing drugs, medical devices, surgical procedures Evaluate & modifies benefits policies, to ensure, that programs are current, competitive, & in compliance with legal requirements, Analyze compensation policies, government, regulations, & prevailing compensation plans Prepare detail job description & classification systems & define job levels & families, in partnership with other managers Develop methods to improve employment policies processes, & practices, & recommend changes to management Negotiate bargaining agreements Conduct exit interviews to identify reasons for employee termination Active listening Assisting with the PCC role Using different systems to make sure patients receive medications on time Working with immunology, oncology, infectious disease, & cardiovascular patients Helping to make sure patients are enrolled into the correct Program that their insurance will cover under their commercial, or governments plan Intake Ensuring that patients meet the federal poverty level Running soft credit checks for patients to make sure they qualify for certain programs Ensuring that patients receive their medication within a timely manner Reviewing patients PEF forms to enroll them in certain program Faxing forms or missing information over to the payor, FRSM, HCP, & the patient for MI, EOB, or additional information12/2021 - 11/2022Client Specialist-Data Entry/ CM/ContractClient Specialist-Data Entry/ CM/Contract BNY Mellon Pershing Bank - Remote December 2021 to November 2022 Updating client accounts Performing a variety of task Responsible for managing time wisely Working alone Open accounts and updating daily accounts. De-escalating work that does not correct in a certain queue that's been assigned. Document all opened and closed accounts that are being worked in a certain queue. Communicate with management using a system called Teams daily. Multitask effectively. Strong written and verbal communication skills Working on beneficiary's accounts Updating TOD accounts Managing New Accounts Managing Death Certificate accounts Managing Adoption accounts Managing Marin Agreement accounts Managing Joint Agreement accounts Updating New Profile accounts Managing re-indexed accounts Updating Updating Marriage Certificates Data Management Bank custody cases Attend daily meetings in Teams10/2021 - 10/2022McKesson,, None SelectedSpecialty Pharmacy Coordinator /Case Manager/SPC/Contract Remx Staffing/McKesson/Beeline October 2021 to October 2022 Managing programs Leading Teams Accountable for initiatives with data Applying best practices. Defining incremental breakdowns of the work for implementation. Value delivery in an accelerated manner Tracking measurements against value articulated at the end of each cycle. Primary point of contact for initiatives through implementation to realize the business case. Providing support to create a solid concrete for collaboration with Business Owners, Product Managers, and Teams as needed. Updating schedules, drive facilities, project decisions, structure agenda's Managing, driving, and following up to completion. Plan meetings internal and events, as well as executes. Detailed oriented and highly organized. Strong ability to communicate effectively and influence. Works well in a Team centered environment as well as the ability to work independently. 13 years of HealthCare experience is a plus. Process design and efficiency PAP referrals Jabra Teams BI Investigations HIPAA Prior Auth Fax Process Consent Process Running test claims Reaching out to HCP office for shipping status for orders Processing prior auth Contacting Payors office to make sure Synagis was received by HCP office. Completing ADV Events as needed Updating Excel Spreadsheet Completing 5nine report Completing Escalations Reporting all FRSM to Synagis Inbox every 2 hours12/2018 - 05/2022Pharmacy TechnicianCVS Pharmacy, Raleigh, NCPharmacy Technician/Part- Time CVS Pharmacy - Raleigh, NC December 2018 to May 2022 Exceptional customer service skills Customer interaction critical key components Maintaining production Drop-off, pick up, drive thru process. Providing 1st fill process Counseling patients about prescriptions after filled as needed or other questions or concerns. Adherence outreach New prescription pick-up: reach out or consolidate prescriptions per patient request. Ready refill services if it's offered per prescription, & explain the process to patient Setup auto refill, explain the process to patient. Setup patients' profile, text message for available prescriptions, demographic information updates, script sync Data entry per prescription while patients in store Provide patient with a TAT. Provide patient with copay if there is a copay Provide patient with other options if insurance want cover medication Start prior auth if medications not covered by insurance Add insurance onto patients' profile. Add a discount card onto patients' profile. Reach out to the provider if the patient has no refills on file. Sending fax over for additional refills Provide patients with short term supply if patients' out of medication & it's not a C2 medication. Process the claim to make sure the claim processes through before providing patient with copay. Following pickup process procedures Offering Pharmacy Health Benefits and Rewards Enrolling patients into Script sync Program Pharmacy Immunizer Completing dosage, administration, frequency process according to the patient's prescription Explain to the patient when, where, how to take the medication, based upon the doctor's requirements. Explaining coordinating benefits Following DEA Laws Expediting prescriptions based upon the system and promised to patient03/2013 - 12/2021QA AnalystOffice Administration, Durham, NCOffice Administration/QA Analyst Conduent Corporation - Raleigh-Durham, NC March 2013 to December 2021 Hiring employees Training employees Monitoring calls Motivating agents to meet metrics Coaching agents Managing staff Setting certain goals for agents to meet as well as deadlines Greeting visitors Verifying agents' information Scheduling appointments for interviews, visitors, and vendors Supplying refreshments Making copies of plans Dependable Problem solving Works well under pressure Answering and forwarding calls Strong technology skills Time management skills Independent approach to work Research answers for customers diffuse complaints Conduent/Humana Pharmacy: Quality Analyst Creating plans Meeting quality requirements Adhering to the organizations policies Implementing plans with errors to fix low performers Reliability Functionally Coaching low performs as needed Observing calls Demonstrating strong attention to details and analytical as well as problem solving Implementing quality assurance standards Provides accurate & comprehensive feedback Monitor scripts for certain functionally Provide corrective action if the same behaviors are repeated for low performers Meeting expectations Investigations customer complaints and product issues Strong computer skills and knowledge of QA Grade to Mentor/QA guide Side by side with agents Live monitor agents and providing guidance to agents while live monitoring calls Calibration with other sites other than Raleigh, by Zoom One on one coaching obtaining performanceEducation HistoryHigh School DiplomaHigh School DiplomaJames Madison High School, Atlanta, GACertificates and TrainingAED-CPR CertificationPharmacy Technician Certification (National Board of Pharmacy) |
