Team Member A
Resume:
Tonia Lewis 407-***-****
*** **** ***** ***** *** 1 Kathleen Ga 31047 ***********@*****.***
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