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Work Background
Cencora | Pharma solutionsPatient Access Coordinator, Northeast Region Lead
Feb. 2022In this position, I lead a team of 6 throughout regional operations, as well as a Claims Triage team of 10 assisting the Claims department with processing. I oversee all services, including billing and coding support, claims submission and tracking, prior authorization, benefits verification and coordination, alternate coverage research, appeals/denials, support programs, pharmacy triage, and more. Additionally, I am well-versed in medical and pharmacy terminology, billing and coding, and copay assistance. > I coordinated services with our field reimbursement teams, sales representatives, and manufacturer representatives. > I analyzed, reported on, resolved, and communicated reimbursement trends or delays, such as billing or claim denials, pricing errors, or payments, as well as managing initial customer escalations and issue resolution. > I liaised with internal and external service providers to manage and maintain program policies and SLAs, as well as verifying transaction and process compliance with proprietary policies, recommending solutions or changes as needed. > I was the point of contact for internal and remote associates’ training. > Additionally, I evaluated our processes for potential improvement, supported new quality initiatives organization-wide, and trained 200 interim associates for the 2023 Annual Reverification season as an interim Quality Analyst (QA).
Lash GroupPatient Access Specialist
Apr. 2019 - Apr. 2022Fort Mill, SCI handled both patient and provider concerns and inquiries, health insurance claim issues, and general operations in collaboration with Area Regional Managers, as well as controlling documentation processes to ensure accuracy and regulatory compliance. > It was essential to update reference materials with Medicare, Medicaid, and 3rd-party payer requirements, guidelines, policies, and accepted insurance plan lists.
> Presentations to leadership included project performance tracking and reports on trend analytics. > I provided remote and onsite evaluations and training for employees as part of the Annual Reverification season; I trained and led a team of 25 remote associates throughout the 2022 Annual Reverification season as an interim Support Assistant Liaison (SAL).
Lash GroupSenior Reimbursement Counselor
Sep. 2015 - Apr. 2019Fort Mill, SCI verified our Rheumatology and Oncology patients’ benefits for authorization for intravenous and subcutaneous procedures with system-generated queues, payer sites, and direct calls, and reviewed and analyzed claims for services rendered. Another aspect of this position was to provide specialized benefit verification for high-profile clients, home infusions, and specialty pharmacy benefits. > I coordinated with provider representatives, 3rd-party customer service representatives, and pharmacy staff to ensure quality care. > Seasonal verification specialists came to me for onboarding, orientation, and training. > I also provided coding and billing support, appeals and denials, and correspondence.
Lash GroupPatient Case Coordinator
Jul. 2014 - Sep. 2015Fort Mill, SCI answered clinical and program inquiries and processed incoming program enrollment forms, identifying supplementary and alternative healthcare coverage sources for patients as needed. Additionally, I utilized standard operating procedures (SOP) to analyze data and mitigate issues.
MONTCLAIR PUBLIC SCHOOLSParaprofessional
Jan. 2008 - Mar. 2014Montclair, New Jersey, United StatesI provided individual care and student supervision, assisting students with classroom assignments in individual and group environments. I also assisted the Teacher with instruction and student supervision as needed.
Optima Technology PartnersHuman Resources (HR) Manager
Jan. 2005 - Jan. 2008I manage our employee retirement benefit and disability claim administration, medical and life insurance enrollment, and 401(k) benefit and payroll, as well as office operations and directing client, employee, and vendor inquiries. > I spearheaded a new employee orientation, covering company policies and procedures, culture, and campus. > Following weekly, biweekly, and monthly timelines, I directed, organized, and prepared accounting invoices. > I was the point of contact for HR issues, including vacation and sick time, benefits administration, job services, and employment discrepancies. > Additionally, I controlled the President’s international and US appointment calendars, as well as travel throughout India, the US, and Canada. I coordinated client lunches, conferences, and travel, as well.
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