Jose Cruz

*** ********** ***. **********, ** ****3 ad4l6w@r.postjobfree.com

973-***-**** https://www.linkedin.com/in/jose-cruz-1947491a/

You will find that I have extensive experience in Field Reimbursement Leadership, Market Access, and Sales Management. Your recent advertisement on the LinkedIn Professional site for Senior Field Reimbursement Manager captured my attention. I have included a copy of my resume for your review.

Below is a summary of several of your job requirements and how I meet and/or exceed them.

Position Requirements

My Qualifications

Bachelor’s degree required.

5 years of Market Access/Sales experience is required.

Master’s Degree in Economics, Lean Six Sigma Green Belt.

10+ years of market access, sales, and healthcare program experience. Progressive roles have included serving as a Healthcare Representative, Sales Support Representative, and my present position as a Field Reimbursement Specialist.

Experience / Contributions include:

Promoted to coordinate the authorization process with hospital personnel, payer representatives, and Zoll reimbursement operations.

Serve as a point of contact for field sales, leadership, and payors during the reimbursement process.

Execute the strategic vision. Monitor performance, author short and long-term roadmaps, and develop and implement process improvements, driving the achievement of market access, profit, and operational goals.

Build relationships with internal teams, customers, and partners. Provide support, as well as staff, customer, and partner education on programs and services.

Develop new and interactive reports for field sales and national accounts teams to break down date and document issues with not just payors, but down to the prescriber level to identify future trends.

Partner with the national accounts team, ensuring that the field reimbursement specialist activities support the managed care goals and objectives while maintaining customer profile data on the different layers of managed care contacts, medical policies, and reimbursement trends of billed accounts.

Coordinate reimbursement-focused activities for field sales, proactively educating hospital and payor case management, preparing appropriate documentation packages for authorizations, and understanding and communicating the managed care flow of the geography.

Developed and implemented a new process with the Veterans Association Medical Center, resulting in an increase of 75% in revenue within the first year.

Created a partnership with a historically negative insurance payor by challenging their interpretation of their own medical policy, resulting in the initial protection of more patients at an immediate rate, leading to an increase in revenue by 15% in fiscal year 2022.

Assembled and led a team of 16 to address issues with state Medicaid program policies for NJ and NY negatively impacting the continued protection of patients from sudden cardiac death.

The enclosed resume presents a more detailed listing of my capabilities. I would welcome the opportunity to meet with you personally to discuss how I can employ my talents to support the continued success of your company.

Thank you in advance for your consideration.

Sincerely,

Jose Cruz

Jose Cruz

185 Belleville Ave. Bloomfield, NJ 07003 ad4l6w@r.postjobfree.com

973-***-**** https://www.linkedin.com/in/jose-cruz-1947491a/

EXECUTIVE SUMMARY

An innovative and goal-driven Field Reimbursement Specialist and key team member, with proven ability to identify and understand client’s needs, create solutions, and deliver value.

Communication / Relationship Building: Exceptional communication, negotiation, and presentation skills. A thought leader and influencer with the ability to build robust and mutually beneficial business relationships at all levels. Adept at translating complex information into audience-appropriate and actionable terminology.

12+ years’ including vision and strategy execution, patient access, foundation, and bridge programs, as well as rare disease, and specialty product launches, B2B/B2C sales management, team building/training, customer success, marketing, multiple account management, data analysis, financial analysis, policy & regulatory compliance, and service management.

Continuous Improvement: Experienced in root-cause analysis, data-driven solutions, and process re-engineering.

Trusted Advisor: Build and cultivate relationships with clients, cross-functional teams, and partners. Serve as access and payer Subject Matter Expert (SME), and provide advisement on strategy development, sales and growth, and process improvements.

Bilingual: English and Spanish

Technical Skills: MS Power BI, HL7, BOXI reporting systems, SQL, and SPSS, MS Office (Word, Excel, PowerPoint, Access, & Outlook), Email/Webmail, Web Research, Social Networking, & Online Collaborative Computing.

Additional Credentials: Master’s Degree in Economics, Lean Six Sigma Green Belt.

CORE COMPETENCIES

Field Reimbursement Leadership

Market Access

Sales / Revenue Growth

Patient Access Programs

Payer Segments

Specialty Markets

Services Education

Value Propositions

HUB / Reimbursement

Support Programs

Financial Support Options

ID / Issue Resolution

Patient / Customer Relations

Strategic Planning / Advisement

Legal / Regulatory Compliance

Goal Attainment

KPIs / Metrics / Trends

Cross-Functional Collaboration

PROFESSIONAL EXPERIENCE

ZOLL LIFEVEST - Pittsburgh, PA 2017 - Present

Field Reimbursement Specialist (2017 - Present)

Promoted to coordinate the authorization process with hospital personnel, payer representatives, and Zoll reimbursement operations. Point of contact for field sales, leadership, and payors during the reimbursement process.

Execute the strategic vision. Monitor performance, author short and long-term roadmaps, and develop and implement process improvements, driving the achievement of market access, profit, and operational goals.

Build relationships with internal teams, customers, and partners. Provide support, as well as staff, customer, and partner education on programs and services.

Partner with cross-functional teams and senior leadership. Ensuring alignment, and providing SME advisement on issues, long-term strategies, product launches, and market opportunities.

Interact with field-level staff to troubleshoot problems, relay information from insurance payors, and help close the gap in the lapse of coverage with given patients.

Develop new and interactive reports for the field sales and national accounts teams to break down date and document issues with not just payors, but down to the prescriber level to identify future trends.

Partner with the national accounts team, ensuring that the field reimbursement specialist activities support the managed care goals and objectives while maintaining customer profile data on the different layers of managed care contacts, medical policies, and reimbursement trends of billed accounts.

Initiate, negotiate, and follow up on letters of agreement with targeted non-contracted payors.

Coordinate reimbursement-focused activities for field sales, proactively educating hospital and payor case management, preparing appropriate documentation packages for authorizations, as well as understanding and communicating the managed care flow of the geography.

Key Accomplishments:

Developed and implemented a new process with the Veterans Association Medical Center resulting in an increase of 75% in revenue within the first year.

Created a partnership with a historically negative insurance payor by challenging their interpretation of their own medical policy, resulting in the initial protection of more patients at an immediate rate, leading to an increase in revenue by 15% in fiscal year 2022.

Assembled and led a team of 16 to address issues with state Medicaid program policies for NJ and NY negatively impacting the continued protection of patients from sudden cardiac death. Coordinate strategies through analytics, and the collaboration of ideas and experiences in developing short-term plans for long-term success.

Sales Support Representative

Communicated with field sales on reimbursement best practices, recent trends with designated payors, and policy updates on the federal, state, and commercial insurance levels.

Key Accomplishments:

Worked with National Accounts Director to address issues, using Power BI data and developing new reports to assist Region and Area Managers with a variety of issues for continued professional development for sales staff.

CHANGE HEALTHCARE - Newark, NJ 2010 - 2017

Healthcare Representative

Collaborated with hospital employees and patients in hospital and home settings to assist clients in obtaining maximum benefit coverage. Participated in process improvement initiatives and maintained teamwork, customer service production, and quality standards to assure timely, efficient, and accurate issue resolution.

Maintained communication with government agencies regarding the status of claims.

Completed applications for state and federal programs that included Health Exchange/Marketplace programs, reviewing medical records, and taking all necessary actions to expedite benefit claims approvals.

Assisted patients in applying for Federal Social Security Administration and State or Local Medicaid programs, adhering to the government's medical definition of disability.

Ensured compliance with company and legal standards on Protected Health Information (PHI), Personal Identifiable Information (PII), and Personnel Transaction Identifier (PTI).

Screened self-pay patients under Medicare, Medicaid, Medicaid for Nursing Home Placement, Crime Victims, vocational rehabilitation, QMB, SSI, and other 3rd party coverages under local, state, and federal programs.

Investigated payment status, determined patient financial responsibility, collected balances, and offered settlement options. Identified and rectified overpayments, and processed refunds, adjustments, and appeals.

Key Accomplishments:

Increased revenue from $275,000 to $350,000 within the final 6 months with the company.

Named employee of the month in 10/2016, recognized for providing outstanding patient care and interactions.

NEW YORK RED BULLS SOCCER CLUB - Harrison, NJ 2016 - 2019

Event Marketing Coordinator (Part-Time)

Planned and executed in-arena event marketing activations including the BULLevard pre-match activation space, on-field match presentations, group sales activations, halftime presentations, special awareness and title night activations, and other major marketing initiatives on match day. Set up and broke down facilities and managed events.

EDUCATION / CERTIFICATIONS

M.A. in Economics, The New School - New York, NY

B.A. in Fine Arts - Humanities, Montclair State University - Upper Montclair, NJ

Six Sigma Green Belt Certified (LGBC) - The Management and Strategy Institute (MSI)

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