Office Assistant Prior Authorization
Resume:
Maria R D’Ampolo
Billerica, MA *****
************@*****.***
Omnipod Sales Specialist September 2018 - Present
Insulet Corporation, Acton MA
Drive the regional US inside sales operations for a multinational insulin pump manufacturer with > $700M in annual revenue. I partner with intake, clinical services, and territory managers in 2-3 territories to effectively supervise sales pipelines with 150-200 patients per quarter. Achieved success via outbound calls for my designated territory to both patients and clinics facilitating the collection of paperwork, benefits delivery, obtaining buy-in, and satisfying prior authorization requirements for new orders. I also take inbound calls from a company-wide queue to assist with all aspects of the ordering process
Product and competitive comparisons.
Commercial, Medicare, Medicaid Insurance and Pharmacy channel Contract, Guidelines & Prior Authorization Expert.
Insurance Contract and Guidelines, Appeals, Patient Care, Billing Medical and Pharmacy Claims.
Patient Advocate and De-escalation Expert.
Pipeline management expert (5+ territories).
Benefits/ Cost Share, HIPAA, Documentation, and New Initiative.
Team Leader, Lead Qualification expert.
Communications and Collaborations Expert (Physicians; Clinical Staff; Field Team; Intake Team; Billing; Claims; Clinical Educators; Marketing Team; Commercial Team; Management; Medical Insurance; Pharmacy Benefit Management)
Sales Partner that brings 150% every day.
Pilot Program providing feedback, suggestions, and support for an environment of continuous process improvement.
High Volume, Fast Paced, Outbound, and Inbound Calls. Recipient of
MVP Award 2018 North Region Circle Of Excellence 2020 MVP Award 2019 North Region Quota Attainment Award 2020 Winners Circle Award 2019 Served On: Inside Sales Advisory Board 2021 Outstand Prior Authorization Approval 2019 Project: DASH LMR FDA LMR Launch 2018 Quota Attainment Award 2019 Project: Pharmacy First Initiative Program 2020-2021 Winners Circle 2020 Project: Omnipod 5 LMR FDA Launch 2022 3
Reimbursement Specialist February 2018 – September 2018 Atlantic Group, Boston MA (Temporary Employee for Insulet Corp)
Insurance contracts, channeling, and processing requirements for all covered products.
Processed all aspects of reimbursement by contacting payors, verifying insurance benefits, and adhering to medical guidelines for reimbursement.
Submission of all prior authorization requests for approval and payment of Insulet products at the time of claim processing.
Calculated and documented cost share amounts for potential customers.
Collaborated with other commercial teams such as Case Management, OmniPod Sales, and Billing, to ensure proactive communication of potential customers’ order status.
Documented all interactions and calls into the customer database and maintain compliance to HIPAA and other regulating bodies as required.
Provided frequent feedback and suggestions to support an environment of continuous process improvement.
Performed other duties and projects as assigned. Medical Office Assistant September 2015 - February 2018 NWOA, Newton MA
High Volume Orthopedic practice
Verified and updated all demographic and insurance information and collected co-payments, resulting in proper cash reconciliation.
Verified patient insurance and referrals available.
Maintain appointment computer scheduling in accordance with office scheduling policies.
Scheduled diagnostic tests/follow-up appointments for patients.
Scheduled MRIs and injections.
Obtained insurance authorizations for MRIs and Injections
Contacting / interacting with appropriate facilities, such as hospitals, rehabilitation centers, assisted living facilities, etc. regarding patient care.
Preparing for and working through Insurance Audits
HR Administration filing; FMLA claims; other projects directed by management SKILLS:
Pharmacy Benefit Management
Commercial Insurance, Medicare Part D, Medicaid
Sales (DME & Pharmacy)
CRM Software Databases
Prior Authorizations, Appeals
The U.S. Health Insurance Portability and Accountability Act (HIPAA)
Claims, Reimbursement
Office Management
HR Insurance Enrollment and Terminations
ICD-9, ICD-10, and CPT-4 coding
Calendar Management
Google Docs, Microsoft Office
Insurance Contracts and Guidelines
Medical office procedures, policies, practices, and medical terminology
Virginia Mason Hospital-Practice PHO experience
Effective written and oral communication skills
Strong attention to detail
Strong analytical and problem-solving skills
Demonstrates initiative and “do whatever it takes work approach” to get the job done
Exceptional customer service
Team player: the ability to work cooperatively and collaboratively with others (internally and externally) Flexible and resilient in work approach.
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