Case Manager Program Specialist

Titika Palmer

**** ******* ****, **** ******, NC 27587

Phone: 984-***-****

Alt Phone: 984-***-****

Email: ************@*****.***

Employment History

**/****-**/****

Program Specialist

The Lab- Remote June 2023 to Jan 2024

• Outbound calls to payers to obtain benefits

• Close current cases • Obtain MI for insurance claim

• Calling payers for Medicare, Medicaid, other payers

• Faxing PA to providers

• Obtaining benefits for Data Check

• Placing cases in payer delay and following up daily

• Creating payer trend

• Using LCA forms for patients

• Using Salesforces systems

• Using CRM

• Using Teams

• Send emails

• Working from excel

• Using pivot

• Processing PA forms

• Verification of J-code

• Dx codes

• CPT codes

• Medical terminology

04/2023 - 08/2023

Reimbursement Field Case Manager

Reimbursement Field Case Manager Aston Carter/Trial Card - Remote April 2023 to August 2023 • Pharmaceutical Drug Company, • Works with the Market Access Organization task helping HCP navigate reimbursement issues for the drug that FRM is supporting • Attentiveness to detail • Accuracy & possess organizational skills • Coordination of resources with primary & secondary third-party payers • Coding, coverage, & payment systems describing drugs, medical devices, surgical procedures • Evaluate & modifies benefits policies, to ensure, that programs are current, competitive, & in compliance with legal requirements, • Analyze compensation policies, government, regulations, & prevailing compensation plans • Prepare detail job description & classification systems & define job levels & families, in partnership with other managers • Develop methods to improve employment policies processes, & practices, & recommend changes to management • Negotiate bargaining agreements • Conduct exit interviews to identify reasons for employee termination • Active listening • Assisting with the PCC role • Using different systems to make sure patients receive medications on time • Working with immunology, oncology, infectious disease, & cardiovascular patients • Helping to make sure patients are enrolled into the correct Program that their insurance will cover under their commercial, or governments plan • Intake • Ensuring that patients meet the federal poverty level • Running soft credit checks for patients to make sure they qualify for certain programs • Ensuring that patients receive their medication within a timely manner • Reviewing patients PEF forms to enroll them in certain program • Faxing forms or missing information over to the payor, FRSM, HCP, & the patient for MI, EOB, or additional information

12/2021 - 11/2022

Client Specialist-Data Entry/ CM/Contract

Client Specialist-Data Entry/ CM/Contract BNY Mellon Pershing Bank - Remote December 2021 to November 2022 • Updating client accounts • Performing a variety of task • Responsible for managing time wisely • Working alone • Open accounts and updating daily accounts. • De-escalating work that does not correct in a certain queue that's been assigned. • Document all opened and closed accounts that are being worked in a certain queue. • Communicate with management using a system called Teams daily. • Multitask effectively. • Strong written and verbal communication skills • Working on beneficiary's accounts • Updating TOD accounts • Managing New Accounts • Managing Death Certificate accounts • Managing Adoption accounts • Managing Marin Agreement accounts • Managing Joint Agreement accounts • Updating New Profile accounts • Managing re-indexed accounts • Updating • Updating Marriage Certificates • Data Management • Bank custody cases • Attend daily meetings in Teams

10/2021 - 10/2022

McKesson,, None Selected

Specialty Pharmacy Coordinator /Case Manager/SPC/Contract Remx Staffing/McKesson/Beeline October 2021 to October 2022 • Managing programs • Leading Teams • Accountable for initiatives with data • Applying best practices. • Defining incremental breakdowns of the work for implementation. • Value delivery in an accelerated manner • Tracking measurements against value articulated at the end of each cycle. • Primary point of contact for initiatives through implementation to realize the business case. • Providing support to create a solid concrete for collaboration with Business Owners, Product Managers, and Teams as needed. • Updating schedules, drive facilities, project decisions, structure agenda's • Managing, driving, and following up to completion. • Plan meetings internal and events, as well as executes. • Detailed oriented and highly organized. • Strong ability to communicate effectively and influence. • Works well in a Team centered environment as well as the ability to work independently. • 13 years of HealthCare experience is a plus. • Process design and efficiency • PAP referrals • Jabra • Teams • BI Investigations • HIPAA • Prior Auth • Fax Process • Consent Process • Running test claims • Reaching out to HCP office for shipping status for orders • Processing prior auth • Contacting Payors office to make sure Synagis was received by HCP office. • Completing ADV Events as needed • Updating Excel Spreadsheet • Completing 5nine report • Completing Escalations • Reporting all FRSM to Synagis Inbox every 2 hours

12/2018 - 05/2022

Pharmacy Technician

CVS Pharmacy, Raleigh, NC

Pharmacy Technician/Part- Time CVS Pharmacy - Raleigh, NC December 2018 to May 2022 • Exceptional customer service skills • Customer interaction critical key components • Maintaining production • Drop-off, pick up, drive thru process. • Providing 1st fill process • Counseling patients about prescriptions after filled as needed or other questions or concerns. • Adherence outreach • New prescription pick-up: reach out or consolidate prescriptions per patient request. • Ready refill services if it's offered per prescription, & explain the process to patient • Setup auto refill, explain the process to patient. • Setup patients' profile, text message for available prescriptions, demographic information updates, script sync • Data entry per prescription while patients in store • Provide patient with a TAT. • Provide patient with copay if there is a copay • Provide patient with other options if insurance want cover medication • Start prior auth if medications not covered by insurance • Add insurance onto patients' profile. • Add a discount card onto patients' profile. • Reach out to the provider if the patient has no refills on file. • Sending fax over for additional refills • Provide patients with short term supply if patients' out of medication & it's not a C2 medication. • Process the claim to make sure the claim processes through before providing patient with copay. • Following pickup process procedures • Offering Pharmacy Health Benefits and Rewards • Enrolling patients into Script sync Program • Pharmacy Immunizer • Completing dosage, administration, frequency process according to the patient's prescription • Explain to the patient when, where, how to take the medication, based upon the doctor's requirements. • Explaining coordinating benefits • Following DEA Laws • Expediting prescriptions based upon the system and promised to patient

03/2013 - 12/2021

QA Analyst

Office Administration, Durham, NC

Office Administration/QA Analyst Conduent Corporation - Raleigh-Durham, NC March 2013 to December 2021 • Hiring employees • Training employees • Monitoring calls • Motivating agents to meet metrics • Coaching agents • Managing staff • Setting certain goals for agents to meet as well as deadlines • Greeting visitors • Verifying agents' information • Scheduling appointments for interviews, visitors, and vendors • Supplying refreshments • Making copies of plans • Dependable • Problem solving • Works well under pressure • Answering and forwarding calls • Strong technology skills • Time management skills • Independent approach to work • Research answers for customers diffuse complaints • Conduent/Humana Pharmacy: • Quality Analyst • Creating plans • Meeting quality requirements • Adhering to the organizations policies • Implementing plans with errors to fix low performers • Reliability • Functionally • Coaching low performs as needed • Observing calls • Demonstrating strong attention to details and analytical as well as problem solving • Implementing quality assurance standards • Provides accurate & comprehensive feedback • Monitor scripts for certain functionally • Provide corrective action if the same behaviors are repeated for low performers • Meeting expectations • Investigations customer complaints and product issues • Strong computer skills and knowledge of QA • Grade to Mentor/QA guide • Side by side with agents • Live monitor agents and providing guidance to agents while live monitoring calls • Calibration with other sites other than Raleigh, by Zoom • One on one coaching obtaining performance

Education History

High School Diploma

High School Diploma

James Madison High School, Atlanta, GA

Certificates and Training

AED-CPR Certification

Pharmacy Technician Certification (National Board of Pharmacy)

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