Tonia Lewis 407-***-****

*** **** ***** ***** *** 1 Kathleen Ga 31047 ad301g@r.postjobfree.com

Professional Profile

A professional, loyal and clearly dedicated individual, with ambition to succeed in any environment. I am seeking a stable position which will allow me to obtain long term employment and utilize my expertise.

Excellent organizational skills

Able to work independently and as a team member; adapt at motivating staff to ensure smooth work-flow and increased

Professional and personable in relating with clients and co-workers

Self-motivated; able to set effective priorities to achieve immediate and long-term goals and meet operational deadlines

Utilizes all available resources to obtain and enter insurance coverage information for ordered services into patient’s file.

On the floor trainer for new hires

Ability to remain calm, patient as well as productive in a fast passed environment

Proficient in MS Windows, MS Word, MS Excel, MS PowerPoint, MS Office, Atlas/Turbo Cap/NICE Interaction Management

Facilitator of Responsible for verifying patient eligibility, coordinating benefits, running test claims and determining primarily major medical insurance benefits verification, complex insurance plan verification and high volume PBM plans.

Provides notification of urgent orders to the Senior level or Group Supervisor and communicates with other departments when an urgent need for filling a prescription or refresher trainings to existing employees

Professional Experience

CVS Health

April 2022-current

Service Advocate

Inbound and outbound calls to answer questions and education members about benefits and programs available to them through their plan.

Seamlessly navigate multiple systems to investigate and resolve complex issues while providing accurate and complete documentation

Work independently to provide an exceptional consumer experience, honoring commitments and collaborating with team members.

AllianceRx Walgreens+Prime

Insurance Verification/Submissions /Wait for Payment/Patient Financial Service

May 2018-October 2018

Team Lead/Senior(over 80+employees)

October 2018-March 2022

delivery is necessary. Places outbound calls to patients or physicians’ offices to obtain additional information needed to process the script or to notify of delay in processing script.

Manages inbound calls on the Insurance line from patients, clients, physicians, practitioners, clinics and internal departments regarding inquiries about services provided, financial responsibility and insurance coverage.

Assist Supervisor and other Seniors/Team Leads with Escalations, Supervisor Calls, System Reports, Email communication, Work Assignment, Team Work Assignment

Monitor and evaluate patients experience to ensure that representatives are following policy and procedures. Also provide feedback on areas of improvement

Centene Corporation/ Acaria Health

Insurance Verification Coordinator/Escalations Team

September 2014-October 2017

(temp March 2014 to September 2014)

Obtain and verify insurance eligibility for services provided and document complete information in system

Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies

Collect any clinical information such as lab values, diagnosis codes, etc.

Determine patient’s financial responsibilities as stated by insurance

Configure coordination of benefits information on every referral

Ensure assignment of benefits are obtained and on file for Medicare claims

Bill insurance companies for therapies provided

Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures

Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs

Handle inbound calls from patients, physician offices, and/or insurance companies

Resolve claim rejections for eligibility, coverage, and other issues

Assist Account Executives with patients orders and delivery

Cornerstone Certificates

Decision Making: The Fundamentals

Effective Team Communication

Applying Basic Data Formatting in Excel 2010

The 7 Habits for Managers*scheduled in 02/2016

Express Scripts

Eligibility Liaison/Alternative Funding Specialist/ Patient Care Coordinator

November 2008-November 2012

Consistently handled 50+ inbound/outbound phone calls on daily basis.

Followed the standard operating procedure and job aids for the program.

Confirmed pharmacy benefits for all new referral have been received.

Served as a liaison between the doctor offices, insurance companies and patients with co-pay or co-insurance based on patients plan structure.

Obtained co-pays from patients and schedule deliveries to doctors’ offices

Alternative Funding Specialist

Followed the standard operating procedure and job aids for the program.

Confirmed the ICD.9 code for all new referral have been received

Served as a liaison between the patient and the independent non-profit organization

Addressed the various types of incoming patient, Genentech Access

Solutions, provider and partner call

Maintained non-Influential Behavior

Sent correspondence to patients and physician as appropriate

Offered Patient Support Link Services to qualifying patients

Patient Care Coordinator

Handled customer service inquiries from members, providers, physicians and internal and external clients related to pharmacy benefits.

Assisted members in understanding and maximizing the use of their pharmacy distribution program.

Handled inbound and outbound member provider and physician calls.

Answered questions related to pharmacy benefits.

Worked collaboratively with other customer service representatives and supervisor to ensure that best- practices are shared.

Prior Authorization and IV Certified

Education

Bachelors of Chemistry

Fort Valley State University,

Fort Valley, GA.

2004

References

References are available upon request.

Contact this candidate