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Click here or scroll down to respond to this candidateRESUMECandidate's Name
PROFILE SUMMARYAccomplished and results-driven professional with over a decade of experience in healthcare operations and reimbursement management. Proven expertise in navigating complex reimbursement landscapes, optimizing operational efficiency, and leading cross-functional teams to exceed performance targets. Adept at developing and implementing strategic plans to enhance patient access to therapies while ensuring compliance with regulatory requirements. Recognized for exceptional problem-solving skills, stakeholder engagement, and a commitment to delivering high- quality service in fast-paced environments. Encompassing key values of integrity, honesty, appreciation, teamwork, growth, and result orientation with an eye toward continuous improvement. Highly creative and innovative, with a big-picture perspective. CORE COMPETENCIESAbility to make important policy, planning, and strategy decisionsAbility to develop, implement, and review operational policies and proceduresSkilled in counseling, problem-solving, and conflict management to ensure smooth workflowSuperior memory for details and skilled in multitasking to prioritize and manage multiple tasksSolid time management with high precision in delivery in a deadline-oriented environmentStrong written and verbal communication skills for documentation and correspondenceGreat team player who loves to establish trust and a collaborative work environmentProficient in computer systems and Microsoft Office (Word, Excel, PowerPoint) PROFESSIONAL EXPERIENCEHealthcare Document Manager July 2023 - Feb 2024CareMetx, LLC - Bethesda, MD, United StatesServing as the primary contact for document creation, requests, and support.Collaborating on developing communications, including letters, emails, and scripts, with various teams.Ensuring documentation is uploaded, assigning appropriate owners and approvers in the CareMetx system.Monitoring deadlines, ensuring timely approvals, reviews, and revisions.Managing and triaging customer documentation requests, providing updates, and managing expectations.Negotiating priorities and resources with internal and external stakeholders for project success.Conducting meetings to discuss and document new or revised documentation with stakeholders.Leading and preparing for cross-functional status meetings with customers.Developing and managing Hub Program Content, tracking asset expiration dates and timelines.Developing and implementing program SOPs, Work Instructions, and Process Flows. Operations Supervisor Dec 2021 - Jul 2023CareMetx, LLC - Bethesda, MD, United StatesSupervised employee performance to ensure task completion within guidelines and deadlines.Conducted performance evaluations and provided constructive feedback to team members.Coach staff to enhance skills and capabilities, providing daily guidance on duties and responsibilities.Resolved work-related issues among associates and assist in recruitment and termination processes.Created training materials, maintained transparent communication, and fostered a positive work environment.Identified program challenges and proposed effective solutions.Cultivated strong relationships with internal and external clients.Ensured compliance with contractual obligations and collaborated on project task plans and SOPs.Analyzed reports, identify patterns, and recommend improvements.Report Adverse Events (AEs) per established procedures and fulfill other assigned duties. Care Manager Jul 2019 - Aug 2020AllCare Plus Pharmacy - Northborough, MA, United StatesConducted thorough benefit investigations with insurance companies to determine coverage eligibility.Process OptimizationData AnalysisPerformance EvaluationOrganizational SkillsStrategic PlanningDocumentation & ReportingProject ManagementResearch SkillsRisk AssessmentTime ManagementNegotiationProblem SolvingPeople-OrientedExcellent CommunicationCustomer ServiceLeadership & TeamworkQuality AssuranceMicrosoft OfficeNorth Carolina Agricultural andTechnical State UniversityAug 1992 - May 1996SKILLSEDUCATIONPHONE NUMBER AVAILABLEEMAIL AVAILABLECharlotte 28216, USALINKEDIN LINK AVAILABLEwashington-65414936T/WCONTACTCompleted prior authorizations accurately, ensuring all information was correct.Guided patients through copay assistance program enrollments from manufacturers and non-profits.Provided exceptional customer service with courtesy, friendliness, and efficient assistance.Worked independently and collaboratively to complete tasks and enhance quality outcomes. Special Project Liaison Apr 2018 - Aug 2018Cencora - Lash Group - AmerisourceBergen Fort Mill, SC, United StatesTrained team members on SOPs, ensuring they are current and addressing any questions.Prepared agendas and document notes for team meetings, recording all discussions and decisions.Tracked progress on initiatives to ensure deadlines are met and goals are achieved.Communicate program contractual obligations to team members to drive optimal performance.Explored and implemented innovative approaches to enhance service quality and program effectiveness.Compiled and delivered routine reports on program operations to management and clients.Identified issues, conducted investigations, and recommended effective solutions for implementation.Developed and proposed innovative solutions to streamline and improve current processes.Monitored team adherence to SOPs to ensure consistency and quality in program delivery. Team Coordinator May 2016 - Apr 2018Cencora - Lash Group - AmerisourceBergen Fort Mill, SC, United StatesProvided daily guidance on performance metrics and program processes, ensuring adherence to standards.Identified training needs and delivered SOP training, addressing team members' questions and concerns.Prepared agendas and document notes for team meetings.Tracked progress on various initiatives to ensure deadlines are met.Spend 50% of time mentoring associates and addressing their questions.Communicate program contract obligations to drive performance.Proposed and implement innovative approaches to improve current services.Compiled and delivered routine reports on program operations to management and clients. Interim Team Coordinator Oct 2015 - Feb 2016Cencora - Lash Group - AmerisourceBergen Fort Mill, SC, United StatesActed as the main point of contact for a team of 20-25 contingent associates.Offered daily guidance on performance metrics and program procedures to ensure alignment with standards.Provided feedback on training needs and actively participated in team meetings.Engaged with associates 50% of the time, collaborating with the contingency agency.Sought innovative strategies to improve services, and compiled routine reports for management and clients.Assisted in creating processes, monitored compliance, audited program activities, and updated permissions.Identified issues, conducted investigations, and proposed and implemented solutions. Reimbursement Counselor-Site Coordinator-Fax Reviewer Aug 2012 - Oct 2015 Cencora - Lash Group - AmerisourceBergen Fort Mill, SC, United StatesMaintained regular phone communication with provider representatives, third-party customer service, and pharmacy staff.Provided consultative services for benefit investigations, prior authorizations, and claims research.Reported reimbursement trends and delays to the supervisor, ensuring billing accuracy.Ensured confidentiality of patient account status and financial affairs.Mentor seasonal associates to meet program metrics, providing real-time feedback.Review benefits verification for accuracy and update information accordingly.Assisted in launching and training employees on new drugs and driving continuous improvement initiatives. Account Specialist Lead 2002 - 2010Wachovia Bank - Charlotte, NC, United StatesAdhered to Loss Management procedures and applied risk policy accurately to decision accounts.Led and managed the Misapplied Payment process for the Consumer Customer Support Division.Maintained a comprehensive audit trail for audit requirements and quality assurance purposes.Partner with internal client teams to seek approval for special handling clients.Participated in developing short- and long-range Exception Monitoring enhancement strategies.Performed risk analysis on commercial and consumer accounts, ensuring accuracy and compliance. Accounting & Risk Management and Operations 1996 - 2002 First Union Bank - Charlotte, NC, United StatesServed as primary contact for Accounting and Operation Representatives.Initiated and verified electronic requests for time-sensitive customers.Interacted with high-level relationship officers, client managers, and banking center branch managers.Processed payments with exception conditions and resolved missing payment inquiries.Ensured timely processing of payments and fee adjustments with minimal customer impact.Provided training and possess a comprehensive knowledge of First Union systems and services. |
