Support Staff Benefits Coordinator

PATRICIA KNOX

WORK EXPERIENCE

CVS June ****-Present

BV Representative

Analyze the Salesforce benefit information for verification for different Lines of Business (Commercial, Medicare, Medicaid) within the PBM

Process claims through Peoplesafe-Ce2000 and HBS

Obtain authorization for specialty medications and nursing using J, S, A, NDC #, and nursing codes

Utilize the Sparc’s system to move patients to their next step in care (i.e., home, doctors’ office, AIS)

Orsini January 2018-June 2018

Benefits Coordinator

Reviewed information to verify benefits eligibility for Vivitrol

Oversaw document management and retention of patient records

SOLEO Health 2017-January 2018

Intake Coordinator Manager

Provided oversite and training of pharmacy technicians and support staff

Reviewed all referrals to assure that the diagnosis is in-line with the criteria for the medication being dispensed and administered

Assisted in coordination with hospital and patient services

Coordinated with our Corporate and Analyst team to collect all documents to qualifying patients

Oversaw document management and retention of patient records

Option Care (Acquired from Walgreens) 2015-2017

Senior Insurance verification / Benefits Coordinator Lead

Supervised pharmacy technicians and support staff

Provided new hires and on-going training for new projects and changes that occurs with new contracts

Handled Claims for Medicaid and Medicare Patient with the knowledge of the Cost, AWP & U&C pricing

Reviewed all referrals to assure that the diagnosis is in-line with the criteria for the Medication being dispensed and administered

Coordinated with our Corporate and Analyst team to collect all documents to qualifying patients for TPN-Inotropic, high dollar drugs, and specialty formulas, Chemo- 5-FU and Cytarabine

Walgreens (Currently Option Care)

Senior Insurance Verification / Benefits Coordinator Lead 2008-2015

Clinical Benefits/ Insurance Verifications 2003-2007

Supervised pharmacy technicians and support staff

Provided new hires and on-going training for new projects and changes that occurred with new contracts

Handled Claims for Medicaid and Medicare Patient with the knowledge of the Cost, AWP & U&C pricing

Reviewed all referrals to assure that the diagnosis is in-line with the criteria for the Medication being dispensed and administered

Coordinated with our Corporate and Analyst team to collect all documents to qualifying patients for TPN- Inotropic, high dollar drugs, and specialty formulas, Chem-5-FU- Cytarabine

Ultra Care 2000-2003

Lead Intake Coordinator/Lead Synagis Coordinator

Calculated Synagis dosing per patient weight in kilograms to be dispensed under the supervision of a licensed Pharmacist

Scheduled registered nursing visits per patient next dosing schedule

Created spread sheets to enter data with HT, WT, Allergies, Diagnosis, ICD-10 - HPCS, and S.O.C date

Verified benefits and eligibility with deductible, out of pocket with lifetime maximum, and visit maximum

Obtained pre-authorization & pre-determination of medication and homebound status

Handled inbound and outbound calls from referral sources including healthcare facilities, healthcare providers, social workers, and liaisons

Caremark 1998-2000

Senior Pharmacy Intake Coordinator Lead

Led the Synagis Team

Reviewed and updated patient data upon receipt of referral

Calculated Synagis dosing per patient weight in kilograms to be dispensed under the supervision of a licensed Pharmacist

Verified benefits and eligibility for new and existing patients

Set up monthly nursing visits with a pediatric nurse to administer medications

EDUCATION

School of Pharmacology - Chicago, IL

Certified/Licensed Pharmacy Technician

Dawson Technical College - Chicago, IL

License Practical Nurse Program

Truman College - Chicago, IL

Certified Nursing Assistant/Medical Technology

COMPUTER PROGRAMS/SOFTWARE

Microsoft Office

Salesforce

CPR

Emphaysis

E-Care

MRO

KIS

DayTech

Allscript

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