Senior Reimbursement Coordinator
Resume:
Sonia Winchester- Lingham
Addison, Texas 75001
Phone: 301-***-****
Email: *************@*****.***
HEALTHCARE MANAGEMENT EXECUTIVE
Reimbursement Corrdinator with formal education in healthcare management and more than 7 years of experience overseeing the appeals process and claims. Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology to assist in the preparation of complex reports for managed care organizations and insurance companies. Works effectively with internal and external customers to provide excellent customer service to build strong working rapports benefiting the organization’s objectives. Excellent at team-building, handling confidential information, focusing on details and problem solving. Additional Core Competencies include:
Business Development
Client Acquisition & Retention
Claims Management
Project Management
Medicare Best Practices
Contract Negotiations
Professional Experience
2/24/14 TO PRESENT
USBioservices/AmerisourceBergen
Frisco, Texas
SENIOR REIMBURSEMENT COORDINATOR
Responsible for Cash and Charge reconciliation for Pharmacy Benefits Management/Patient Reimbursement/Credit Cards/ MFG & charitable Org. and completing the Adj.’s in PRX and OSRX system equal to 8 million a day.
Conduct various reimbursement functions, including but limited to accurate and timely claim submission, claim status, payment posting, and/or refunds, until accounts receivable issues are properly resolved for Pharmacy Benefits Management.
Handling the PAP Program (CDF, PANF, PAP, LLS, and other charitable program)Collects and reviews all patient insurance benefit information
Complete and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors.
Research and resolves any electronic claims denials, driving the revenue cycle.
Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalate complaints accordingly.
Works on problems of moderate scope where analysis of data requires a review of a variety of factors.
Performs related duties as assigned by the cash team
Complete Mock Closing & Month End for the Cash Team
7/1/11 TO 2/24/14
Theracom/AmerisourceBergen
Rockville, Mryland
SENIOR REIMBURSEMENT CARE ADOCATE
Handling inbound/outbound calls to patients, neurologists, and specialty pharmacies.
Verifies drug card and/or major medical benefits; Performs on-line claim tests. Investigates /brings resolution to on-line insurance rejections; accurately assigns proper payer for all patient coverage requests. Develop working relationships with office staff, provide patient casework & facilitate all aspects of the reimbursement process for enrolled patients.
Determines which potential coverage components of insurance plans (Rx, medical, DME, home health, etc) are appropriate provisions to cover the therapy as well as differentiate coverage by site of service (hospital, home or office). Register, complete benefit verification and coordinate with physician/prescriber or prior authorization as needed.
Identifies/confirms pricing/reimbursement for patients &/or health care providers. Research payers to identify existing contracts, determine if particular specialty products are covered by a contract or coverage policy, & determine the best step is to take if no coverage policy is in place. Options for decisions will include adding product to an existing policy, seeking avenue for a new policy, entering into case by case agreements. Defines which specialty pharmacy provider should dispense on particular cases taking into consideration contractual and other defined operational rules. Uses good judgment to determine when it is appropriate to aggressively pursue Assignment of Benefits (AOB) as requested by the treating physician.
Obtains authorizations for full scope of billable therapy (drug/supplies/training/etc.) based on the specific clinical use for that patient; confirm authorizations in writing. Define scope of authorization (medical necessity/specific dosing/pricing); conform to all requirements in order for authorizations to be kept current. Define claim submission requirements including method of submission (electronic/paper), format, codes, wording, etc. unless otherwise defined by payer. Facilitate agreements with insurance case managers. Define and obtain any medical information required by an insurer.
Provided HIPPA guidelines and procedures in reference to release of information services for patients and insurance statues.
Knowledge of the Reimbursement Support Program; PAP (Patient Assistant Program); Able to send out SRx to the patients while waiting for PA to be approved and also after for FDO (First Dose Observation) to be completed.
Working knowledge of Microsoft Word and Excel, and Web-enabled applications.
10/01/06 TO 04/01/11
Medical Account Services, Inc.
Frederick, Maryland
CLOSING OPERATIONS MANAGER
Process Office accounting to include A/R, A/P and office budget.
Make collection calls on delinquent accounts. Invoice over $5,000 per month.
Supervise customer service functions for 5 employees.
Provide exceptional customer service to loan applicants, lenders, and title companies.
Complete, audit and notarize closing documents to ensure proper execution for funding, while following strict lender and FHA/VA guidelines.
Maintain strict confidence and integrity through application of Confidentiality, Patriot Act and Privacy laws.
Create and execute marketing strategies to increase profit, including direct mail and telemarketing campaigns.
Schedule and coordinate appointments to meet production quota.
7/02 - 8/9/06 Express Appraisal Services Brookeville,Maryland
OFFICE SUPERVISOR
Ensured that proper procedures were followed for cash and credit transactions and bank deposits.
Payment posting, batching, transfer and refund allocation.
Balanced daily accounting report. Monthly invoice over $30,000 per month.
Resolved customer complaints or inquiries. Operate corporate switchboard system.
Provided leadership and development for office staff by communication of career opportunities, providing regular performance feedback, and demonstrating positive sales and service behaviors.
Recruited, hired and trained staff.
Coordinated technician schedules. Dispatched field technicians to work sites.
Completed all field appraisal reports and prepared for lender transmittal. Performed drive-by appraisals when needed.
Managed, tracked, and ordered supplies and merchandise inventory as needed. Completed monthly inventory along with month-end sales reports.
Education & Skills
Bachelor of Science in Technical Managment – DeVry University
Technology Snapshot: MS Office: Word, Excel, Access, PowerPoint, Meditech, Saleforce, ScriptMed
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