Patient Services Case Management

Clarisse Hollifield, BSN

*** ******* ******, **********, ** 01453 *************@*****.*** 781-***-****

SUMMARY

** ***** ** **** ********** experience in Reimbursement. Knowledgeable in all levels of health care plans and their processes related to patient benefits and appeals. Self-motivated, detail and goal oriented individual, who is experienced in not only in a directorial position but thrives in a team-oriented environment. Adept at defining client requirement and meeting their needs.

EDUCATION:

Northeastern University

1999 B.S.N Nursing

SKILLS

Team liaison

Strong verbal communication

Conflict resolution

Quick learner

Extremely organized

Team leadership

Process implementation

Client assessment and analysis

EXPERIENCE

Takeda September 2013 to present

Lexington, MA

Sr. Associate Director Patient Services/ Rare Disease – Northeast Region

Onboarding and Access Specialist

25%: Working cross-functionally to identify and lead the resolution of patient access barriers, including: insurance coverage; reimbursement; financial limitations; site of care; procurement/distribution.

Working directly with the following internal and external groups to resolve access issues described above: patients and/or their families and caregivers; public and private payers (local, regional, and national); specialty pharmacies and specialty distributors; patient advocacy organizations; procurement/distribution

Provide expertise and education on local and regional health plan policies, coverage, processes, etc. to the internal patient services organization, the market access field team, and the field sales organization

Educate patients, families, and caregivers on coverage and reimbursement as well as available Shire service

60%: Work with every new Gattex patient to ensure that the patient’s care environment (physician, nurse, injection training nurse, home infusion provider, family and caregiver, pharmacist) understand Gattex and the process for initiating Gattex

Coordinate communication among key players to ensure that the patient has the clinical support required to transition successfully to therapy

Work closely with Shire colleagues (case manager, RBM, and others as necessary) to ensure that all important activities related to starting therapy (e.g., timely physician detailing, injection training, specialty pharmacy delivery) are completed

Accountable for internal and external cross-functional team execution

15%: Participate in regular cross-functional team meetings to coordinate patient services activities and field activities; cross-functional team includes case managers and field sales, and may include other functions as appropriate

Covance, Inc. August 2014 to September 2015

Gaithersburg, MD

Field Reimbursement Manager-Northeast Region

Field Based Reimbursement Manager assigned to the Northeast Region responsible for Palmetto and Cahaba MAC Jurisdictions

One of six Reimbursement Mangers in successful pilot program. Program now being expanded to 24.

Responsible for building out national field reimbursement team.

Developed tracking, reporting, and analysis system for internal and external reimbursement reporting

Worked directly with Key Opinion Leader at Rheumatology Center of Excellence to interpret the changing landscape of the Psoriatic Arthritis and Plaque Psoriasis market

Interviewed and trained four Field Reimbursement Managers in the Northeast/Mid-Atlantic

Featured lecturer at Processing Otezla Prescriptions Speaker programs in NY, NC, ME, NJ and PA

Three of Eleven team members assigned to geography made presidents club (among top 10 of 264 sales professionals)

Shire October 2012 to August 2014

Lexington, MA

HAE Case Manager

•Works closely with patient/family to case manage all steps required to gain access to therapy.

•Acts as the liaison with medical offices

•Work with Specialty Pharmacy and insurance companies to obtain reimbursement information

•Work with Specialty Pharmacy HUB to conduct benefit investigations with insurance companies as required.

•Counsel patient/family on reimbursement options

•Manage patient transition to Firazyr. Work with nurses to provide injection training to patients

•Responsible for maintaining case history for all assigned patients in the CRM system

Trouble shoot and resolve ongoing reimbursement issues (step edits, insurance changes, PA’s, etc.)

•Partner with Field Regional Business Managers and Patient Access Mangers to manage all patient cases within their assigned territories

•Professionally field incoming telephone calls while making a positive impression

•Answer patient and medical office inquiries and resolve customer problems

•Provide ongoing persistency and compliance support by making regular calls to patient/families

•Manage patient assistance requests and work with partners to process applications

•Provide back-up coverage for other Customer Service Case Managers

•Attend scheduled patient Ambassador meetings and represent Shire HGT at industry conferences

•Travel to sales meetings and medical offices as necessary

Insulet Corporation February 2008 to August 2012

Bedford, MA

Reimbursement Team Lead/Manager

•Supervisor of 18 employees in the reimbursement process; verifying insurance benefits, collection of all required documentation, submitting authorizations and coordinating shipment of product to patients with diabetes.

•Recommended changes to existing methods to increase the accuracy, efficiency, and responsiveness of the customer service department.

•Developed, implemented, and monitored programs to maximize customer satisfaction.

•Recruited, managed, and mentored an average of 5 new customer service representatives per year.

•Proficient in the interviewing, hiring, promotions and terminations processes.

•Trained and development new employees the reimbursement process to become effective members of the team.

•Owned team productivity metrics.

• Improved service quality and increased sales by developing a strong knowledge of company's products and services.

•Identified individual development needs with appropriate training.

•Cross-trained and backed up other customer service managers.

•Reduced amount of employee overtime by 25% by effectively delegating tasks.

•Implemented marketing strategies which resulted in 12% growth of customer base.

Appeals Analyst

•Created new revenue streams through appeals of 300 initial patient which

resulted in over $90 thousand dollars of additional revenue for the company.

•Analyzed all medical records, clinical documentation, labs, and blood sugar

readings for patient denials.

•Attended medical insurance board hearings (phone) on behalf of the denied patients.

Senior Reimbursement Coordinator

•Processed initial reimbursement authorizations involving customer contracts, gathering clinical documentation, benefit verification, and confirming product codes.

•Managed all health insurance plans on the West Coast.

•Tracked all stages of the authorization process.

•Document and all customer information to ensure timely verification benefits and order processing/billing.

•Work with Insulet team (sales, finance, and distribution) to ensure cohesive, positive and efficient customer service.

•Delivered superior frontline customer service to the satisfaction of End Users and Health Care Professionals to ensure positive outcomes and impact on future sales Maintained high level of integrity and confidentiality with patient privacy requirements (HIPAA).

HealthBridge, Inc March 2006 to February 2008

Braintree, MA

Clinical Operations Coordinator

•Supervised 6 Appeal Specialists.

•Documented and submitted adult and pediatric appeals for Growth Hormone treatments.

•Aided patient for submission of external appeals

•Attended medical insurance board hearings (phone) on behalf of the denied patients

•Communicate at all levels of the appeals process, including field-based sales, physicians, client partner and managed care positions.

•Research and investigate patient medical benefits, identify opportunities for prior authorizations, and research claim activities.

•Oncology Case Manager

•Processed initial reimbursement authorizations involving customer contracts, gathering clinical documentation, benefit verification, and confirming product codes.

•Managed all health insurance plans on the West Coast.

•Tracked all stages of the authorization process.

Atlantis Rehabilitation Care September 2001 to October 2002

Braintree, MA

Workmen's Compensation Case Manager

•Provided case management services for self-insured worker's compensation program.

•Maintained contact with the injured employee, physician, and employer to assure timely quality medical care and return to work.

•Developed weekly reports and managed reimbursement claims inventory for all vendors.

•Conducted third-party billing.

CERTIFICATIONS

•Emergency Medical Technician

•Cardiopulmonary

•Resuscitation, Radiology

•Manager training - Insulet Corporation

•Member, Alumni Association Northeastern University

•HIPAA

OTHER EDUCATION

Bay State College

1995 A.S Medical Assistant

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