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Outreach Specialist Prior Authorization

Location:
Fort Lee, NJ
Salary:
80,000
Posted:
May 30, 2021

Contact this candidate

Resume:

Curriculum Vitae

Mary Reyes, CSM, PMQ, BS,

Email: admtuo@r.postjobfree.com

LinkedIn: https://www.linkedin.com/in/mreyes2110/

Tel: 718-***-****

Education

William Paterson University, Warren NJ – MBA., Masters in Business Administration

Concentration: Marketing and Human Resources. 2022.

Fairleigh Dickinson University, Teaneck NJ – MAS., Master in Administrative Sciences

Concentration: Administration. 2021

CUNY- Herbert Lehman College, Bronx, NY – B.S., Bachelor of Science

Concentration: Dietetics, Food and Nutrition. 2019.

Work Experience

Kelly OCG/Providing Services for Johnson and Johnson Medical Operations,

Associate Project Coordinator/Specialist (Contract), 01/2021 - present

Provides project coordination support to Medical Operations staff using established tools, systems, and practices.

Coordinates the receipt of documents that are required inputs to Medical Operations deliverables, including downloading documents from the Quality System.

Sets up and drives meetings for project execution per project plan, as well as meetings in support of the project management process.

Drives communication with the project team, including cross-functional partners (such as Medical Directors, Post Market Surveillance, Design Quality Engineers, R&D, and

Regulatory Affairs), sharing deliverables for review and approval.

Ensures project timelines are met and established tools and practices are consistently utilized.

Maintains and monitors metrics relevant to the team activities providing visibility of issues to enable corrective and preventive action to be taken, as needed.

Knowledge and access to applicable Quality Systems to support the teams in routing of documents for approval as well as change orders for document revisions, as required.

Works with cross functional teams to ensure project timeline is met according to cadence schedule.

Aledade, Remote

Patient Outreach Specialist (C0ntract), 10/2020 - 01/2021

Conduct direct telephonic outreach to patients on the provided list.

Follow standard messaging provided by Aledade, and assist patients in setting up an appointment with their PCP.

Apply motivational interviewing tactics to break down psychosocial barriers to appointment creation and attendance.

Track outreach and outcome documentation in the Aledade App and/or in a shared Google Drive document or other tracking system provided by Aledade and on Aledade systems.

Identify outreach trends and cycle back learnings to the team and share creative ideas for increasing patient visits. Retain some degree of flexibility as outreach strategy may shift with greater data availability.

Columbia University Medical Center Department of Neurology Pediatrics, NY

Clinical Coordinator I, 10/2019 - 01/2021

Ensure patients are financially cleared before coming to clinic

Ensure proper reimbursement to pharmacy and hospital accounts.

Confirm that all LOA and contracts are signed by both, insurance and pharmacy to obtain reimbursement of medication through buy- and bill

Coordinating transportation with Medical Outside teams f

Schedule and coordinate Spinraza treatments

Work to financially clear Spinraza treatments and ensure case reimbursement for the hospital and physician(s).

Determine sponsorship/insurance coverage for the treatment

Obtain prior authorization for the treatment

Coordinate receipt of drug with dispensing pharmacy where applicable and track drug deliveries

Responsible person to update, track, and maintain clinical and insurance information in Spinraza patient database.

Calendar Management for all doctors

Scheduling, preparation and planning of meetings,

Document insurance correspondence via calls/faxes/emails/etc. in the “Authorization Status Comments” section

Insurance information, patient’s address and contact info, etc. can all be found in patient’s profile

Review new cases, upcoming procedures, medication shipments, authorization statuses, etc.

Review calendar with CS11 study coordinator, as their research study shares procedure slots/providers with the Spinraza cases

Coordinating MDA visits- manage 300 patients with Neuromuscular Disease

Responsible for tracking dosing on patients in each dosing cohort and adhering to dosing window.

Participates in SMA Spinraza-related treatment planning meetings, participate in weekly team meeting.

Columbia University Medical Center - Department of Neurology Pediatrics

Senior Secretary, 05/2018 - 09/2019

Screens telephone calls and visitors. Handles as redirects inquiries as appropriate.

Identify patients with neuromuscular diseases, particularly spinal muscular atrophy (SMA), and schedule them with appropriate neuromuscular clinicians in private practice or MDA Care Center sessions.

Monitor the EMR systems (crown, IDX) to ensure accurate data entry and follow up, review assigned daily task lists (EMR inboxes) to manage and reconcile billing and other requests for all practitioners in the division.

Utilizes the IDX Web system to manage physicians' patient appointments schedules including but not limited to: scheduling patient appointments, entering patient demographics and insurance information and gathering data for monthly reports.

Coordinates internal and external administrative meetings including SMA Medical Team and SMA Treatment Board meetings. Schedules appointments.

Prepares patient visits.

Review routine reports and other matters submitted for the physician; copy and mail consultation reports and medical record requests.

Perform general support responsibilities (i.e., typing, filing, copying collating and sorting mail).

Maintains follow-up of projects/reports from doctor or manager and informs of critical situations.

61st Service Corporation/Columbia University Department

Medical Assistant, 4/2016-05/2018

•Obtaining authorization for Botox procedures

•Working in conjunction with the epilepsy nurse practitioners and physicians to fill out medical forms for patient, monitor medication schedule of patients and coordinate appointments as needed

•Help the physicians arranging the necessary appointments for patients who undergoes epilepsy surgery, scheduling PET SCANs, fMRIs and closely schedule appointment for patients who has tuberous sclerosis

•Monitor and procure patient supplies. Ensure appropriate equipment and supplies are on hand and in working order for patient dosing day.

•Provide patient education and emotional support during visits.

•Participated in SMA Spinraza-related treatment planning meetings

•Performing general ofce duties such as monitoring physicians IDX schedules, utilize CROWN system to input clinical data information.

•Ordering and maintaining stock of medical supplies for clinic.

•Obtaining authorization for admissions and procedures daily including IVIG, lumbar punctures, MRI and epilepsy and general medications.

Avraham Henoch M.D., Internal Medicine Practice

Medical Assistant, 11/2014 – 02/2016

•Assist in medical procedures such as venipuncture, pap smears and PPD implant.

•Independently performed Electrocardiograms (EKG) and Pulmonary Function Testing (PFT) in adults and children.

•Organize patient flow including monitoring and procuring patient supplies for daily procedures.

•Submit lab orders for finger stick tests, INR, Vaccines and lab supplies inventory.

•Performed vital signs on all patients.

•Reviewed and completed necessary procedure requisitions.

•Delivered specimens to either Labcorp or Quest laboratory as needed.

•Sent prescriptions from department to the pharmacy department.

•Knowledge of CPT & ICD 10 codes for children and adults.

Essen Medical Associates, Comprehensive multi-specialty medical group

Medical Assistant (temporary job), 01/2014 - 04/2014

•Assisted with venipunctures for Psychiatry patients.

•Used Eclinical-Works Software for documentation in electronic medical records.

•Performed authorization and billing for patient procedures.

•Completed patient insurance eligibility and wrote letters of medical necessity for necessary procedures.

•Administered immunizations to children and adults.

•Performed and recorded patient’s vital signs, PFTs, EKGs and PADNETs Vascular tests.

•Worked in phlebotomy drawing blood from children and adults including checking glucose level and INR.

•Collected urine specimens from patients daily.

Skills and Qualifications

Multitask and prioritize projects

Meet deadlines and deliverables

Documentation and reports

Drug procurement.

Experience w/pharmaceutical industry

Electronic medical records: CROWN, WebCIS and IDX, E-Clinical works and Epic.

Knowledge of GCP and FDA regulations. Experience leading projects

Languages: Fluent in English and Spanish

Strong teamwork.

7 years of healthcare experience

Ability to work independently

Administrative decision making

Proactive work ethic

Communications and collaboration.

Proficient with Power Point, Outlook, word and Excel.

Professional

Licenses

CCMA: Certified Clinical Medical Assistant from NHA, Inc

CPT: Certified Phlebotomist Technician from NHA, Inc

PMQ: Project Management Qualified from MSI Institute

CSM: Certified Scrum Master



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