LOPINI L. FINE

**** **** ******, *********, ** **743 ad060b@r.postjobfree.com 407-***-****

OBJECTIVE To obtain the fundamental position in a company which will allow me to utilize my analytical, interpersonal and communication skills. Where professional development through mentorship and training are considered essential to the development and retention of company employees.

EXPERIENCE

Florida Hospital (Adventhealth Maitland)

SEPT. 28, 2015-PRESENT

Consumer Access Representative- Pre-Access

• Check benefits on patient insurance policy to determine coverage. Provide customer service, such as limited instructions on proceeding with claims. Organize work with detailed office records, using computers to enter, access, search or retrieve data. Post or attach information to claim file contact their insurance company retrieve data.

• I work closely with UM by initiating CM codes to request authorizations for inpatient Medicaid accounts. I work KTNN report initiated by financial advocate requesting Utilization Management reviews. I work EQH status report to check Pre-cert status and updated information in Cerner. I work NHI OOS Medicaid accounts by submitting patient information thru NHI web portal. I work APKP and MDNF reports in which UM nurses review and approves authorization updates. I assist with Medicaid registered and discharge worklist. I also work the RMAU report to drop accounts with patient approval. I work Medicaid Out of State by requesting nhi to verify eligibility for the patient. I would call Payors to initiate prior auth over the phone.

Omnicare Pharmacy

DEC. 8, 2014 – MAY 1, 2015

Benefit Investigator

• Contact health plan to verify pharmacy benefits and major medical benefits for multiple Sclerosis medications. Coordinator of benefit of the primary and secondary insurance.

Acariahealth Pharmacy

AUG, 2013 – AUG 2014

Insurance verification specialist and Reauthorization Coordinator

• Verify benefits eligibility thru pbm drug cards or medical benefits. Medical once the OOP has been met, the patient is covered at 100%. The patient does not have any pre-existing conditions and has a lifetime maximum of $0. Confirm that prior authorization (is/is not) required and that the patient has no secondary insurance coverage/and copay assistance. Submit referral to SFO/on-boarding team to release the order. Verify pharmacy benefits the effective date, DED, OOP MAX, Plan Max, prior authorization required, patient copay amount. Troubleshoot error messages on test claims and call health plan to get claim to pay. PAGE 2

Curascript Pharmacy

MAY, 2005 – AUG 2013

Insurance Specialist & Reauthorization Coordinator

• Responsible for complete verification of benefits and eligibility for all referrals referrals received from patient's physician offices and pharmaceutical manufacturers. Investigates benefits & eligibility via telephone internet, database policy & procedures within the first 24 hours of receipt. Consistently processes Medicaid, Medicare and several medical and drug card insurance plans. Resolve necessary overrides for claim and edit rejections due to pharmacy adjudication insurance issues. Communicate with patient on terminated insurance plans and changes in copay needed to process order and transfer patient to another location.

(Point of Contact- Healthnet of California and Brown & Toland) EDUCATION BENNETT COLLEEGE- GREENSBORO, NC COMPUTER SCIENCE & MATH TRANSCRIPT AVAILABLE UPON REQUEST