Rhea Melrose

Healthcare Reimbursement, Patient Advocate and Benefits Specialist

619-***-**** www.linkedin.com/in/justalilrheasunshine ac5ho7@r.postjobfree.com

Summary

Accomplished, knowledgeable, motivated, and hardworking client and customer-focused professional with 15 years of customer care experience across the healthcare and retail sales industries. Delivering excellence in management of processes, procedures and personnel within the healthcare, pharmaceutical, health reimbursement and call center environments. Detailed -oriented and resourceful in completing projects with the ability to multi-task effectively. Experienced working in fast-paced environments demanding strong organizational, technical, and interpersonal skills. Highly collaborative, hands-on subject matter expert committed to superior customer service. Effectively trained employees on company specific policies and procedures. Proven ability to establish rapport with peers, customers, clients, healthcare professionals and patients across all levels of both industries.

Skills & Abilities

Time, Team & Workflow Management and delegation. Teamwork and team supervision

Investigative Research of Insurance Reimbursement, Claims and Prior Authorizations

Data Quality and Data Analysis Reviews

Empower a team by providing constructive feedback and shows interest in teams/members success.

Scheduling and Organization of training classes, team and client management meetings

Continuous Process Improvement and Regulatory Compliance management with ability to adapt quickly

Intermediate knowledge of Windows operating systems, MS Word, MS Outlook and MS Excel

Experience with multiple data bases such as Sales Force, Axis and Siebel

Work Experience

COVANCE MARKET ACCESS- GREENFIELD, IN PROGRAM ASSOCIATE-ASSISTANT SUPERVISOR 11/2016-9/2017

Provided claim support services by identifying reason for denial and low payment and recommended appropriate strategy for the client program

Facilitated support services and managed fast paced call center operations and Communication

Identified program trends and opportunities for intervention with payers and provided recommendations to senior management

Reviewed difficult or special exception cases and provided recommendations to senior management

Conducted teleconference and or WebEx presentations on program specific material

Conducted outbound calls to increase patient compliance with treatment protocols, if appropriate

Managed difficult customers. Served as escalation point of contact for complex reimbursement calls, difficult callers, and customer complaints

Addressed and resolved customer issues, involving customers in the decision-making process to ensure that their needs were being considered

Served as subject matter expert and lent technical expertise

Respond to inquiries from clients, patients, or operations staff regarding third-party payment, patient assistance, or other issues related to client-specific programs

Developed reports, retrieved data as necessary and responsible for generating daily and weekly standard reports

Ensured high-quality work is delivered and performance measures were met

Conducted peer data audits as necessary. Provided informal mentoring to Program Specialists, Program Representatives, and Program Assistants when appropriate

Conducted training for new services and products as needed for veteran staff. Conducted training for new employees assigned to specific programs

COVANCE MARKET ACCESS-GREENFIELD, IN PROGRAM REIMBURSEMENT SPECIALIST 11/2012-11/2016

Conducted in and outbound calls per program specifications and adhering to CQM guidelines

Reviewed specific payer medical policies and/ or pharmacy formularies to determine coverage guidelines for specific medications and/or procedures

Identified program trends and opportunities for intervention with payers to provide recommendations to senior management

Conducted insurance verifications to confirm patient benefits, facilitated the prior authorization process on behalf of customers, assisted with problem claims, and performed case management to identify insurance and alternative funding sources per program specifications

Responded to inbound calls from customers. Triaged calls as appropriate, documented calls in the appropriate database, and handled/escalated calls per program specifications

Screen patient assistance applications by determining eligibility and making outbound follow up calls as necessary

Update computer systems on patient enrollment, denials, approvals, payment processing, withdrawals, shipments, and caller request per program specifications

Responded to inquiries regarding program operations and requests, such as the status of patient enrollment, product shipments, and returns. Also, worked with distributors and manufacturers to request and track product shipment

Enrolled patients into appropriate financial assistance programs, sent copay discount cards through FedEx and enrollment information to provider offices via fax

SAN DIEGO BLOOD BANK SAN DIEGO, CA BLOOD COLLECTION SPECIALIST

05/2007-06/2012

Prepared blood collection procedures & performed venipunctures to collect blood samples for lab references

Trained to perform venipuncture to collect a unit of blood, screening potential donors, recording vital signs and medical history

Demonstrated preparation of phlebotomy equipment for blood donation procedures and collected blood samples in a timely manner to avoid blood clot formation

Worked under the supervision of charge nurse

Maintained department records, reports, and statistical data as required. Performed platelet production as needed

Performed product labeling and quarantined dispositions of products

Screened & registered donor patients, as well as assist colleagues in label and aiding sample collections.

Described the assessment and intervention for each reaction through complete and accurate documentation

Greeting and Registering donors, scheduling appointments, and answering multiple phone lines in a timely manner

Interacted with donors, educating them during their donation using my knowledge about blood banking and blood collection, while making sure that all the customer service standards are being portrayed established and complied

Followed FDA, AABB and HIPPA regulations to ensure the quality of the blood

Trained as apheresis technician to comprehend and follow apheresis procedural guidelines to include specimen collection and processing, instrument operation and troubleshooting, result reporting and record documentation, quality control monitoring, computer applications and safety requirements

EDUCATION

Medical Assistant Diploma- UEI 2005-2006

References available upon request

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