Customer Service Case Manager

May S. Salido

**** ***** ****, ***** ****, CA ***03

*********@*****.*** . 707-***-****

Profile Healthcare – Patient Care Liaison / Reimbursement / Case Manager Dedicated insurance professional with more than 10 years of experience investigating and processing healthcare insurance coverage. Excel in obtaining insurance approval, interpreting policies and coverage solutions. Effectively manage multiple high-priority projects and take provide in providing exemplary customer service.

Key Skills Extensive background with healthcare and case management experience in specialty injectable, medical device or medical/hospital practice. Have Medicare, Medicaid and Commercial insurance expertise, and billing and coding proficiencies. Is internet-research and computer savvy; has strong verbal and written communication skills, problem solving skills and is a team player.

Experience Alexion Pharmaceuticals, New Haven, CT

Patient Liaison, April 2022 – Present

• Build/maintain patient relationships in order to educate, provide ongoing treatment support, and assist with gaining access to therapy.

• Facilitate the coordination of health care provider and payor resources to ensure access to chronic complement inhibition therapy for patients with PNH and aHUS.

• Obtain patient consent and comply with privacy rules.

• Develop and implement individualized care plans for patients.

• Anticipate and prevent or identify and resolve (through coordination of efforts and resources) interruptions or barriers in care.

• Maintain records, complete reports, and communicate case status and direction.

• Organize resources for patient assistance.

• Establish and maintain partnerships with field staff.

• Attend patient meetings, conferences, and trade shows to educate patients, providers, or payors regarding disease/product information and case management services.

• Maintain a current knowledge base regarding insurance options and requirements

(state, federal, and commercial payors.)

• Contribute to the development of departmental policies, procedures, and special projects.

• Participate in and complete required pharmacovigilance training.

• Identify those areas of work and standard operating procedures related to pharmacovigilance.

CAREMETX – Oakland, CA

AMERISOURCE BERGEN (PREMIER SOURCE INC.) – San Mateo, CA Reimbursement Case Manager, 11/07 to March 2022

Case Manager of 2 initial drug launch program

Develop and implement case plans for patients facing undue burden to therapy.

Complete insurance verification, coordination with payers and providers, internal coordination of information, and alternative funding searches.

Execute escalation of payer issue to appropriate resources.

Anticipate and prevent or identify and resolve (through coordination of efforts and resources) interruptions or barrier to care (insurance benefits changes, life-change, provider and/or payer contract issues).

Maintain records, complete reports and communicate case status and direction.

Develop and maintain professional, productive relationships with all internal and external customers.

Maintain a current knowledge of the insurance industry and requirements (state, federal and commercial payers to name a few).

Contribute to the development of departmental policies, procedures and special projects.

Manage a regional case load

GENENTECH, INC. – South San Francisco, CA

Patient Care Liaison Case Manager, 3/99 to 10/03

Case Manager of an initial drug launch program

Coordinate treatment to access Growth Hormone Products with authorization to contracted distributors.

Coordinate shipment of Products to prevent interrupt in therapy

Notify Internal/External Customers, including Physicians Office, Distributors and Sale Force

Evaluate denied cases for Full/mini Appeal.

Evaluate denied cases for interim shipping pending appeal process

Participate in Monthly meeting with Manager/Senior Management representing the department

Primary contact person for distributors to resolve and issues that may arise

First staff member on board to lead Pre-Launch Program for Xolair

Project Leader in 2 projects

Implementation of Computer Screens and Tasking process

Also participating in creating workflow and training of new staff

Manage case load of approximately 150-200 cases

Create / Implement / Modify SOP

BPS HEALTHCARE - Los Angeles, CA

Utilization Management Coordinator, 1/97 to 12/98

Coordinate request for Transition of Medical Care

Overrides and Prior Approval for Maternity Care

Assist Customer Service Department in completing enrollment

Assist Provider Relations and Marketing Representatives in educating new customers.

Proofread Provider Database for Directory

Participate in Performance Review / Manage staff of 6 AETNA US HEALTHCARE - Chicago, IL

Utilization Management Coordinator Team Lead, 1/92 to 7/96

Provide support to Utilization Management Department to facilitate appropriate healthcare treatment, Effectively manage healthcare cost and improve healthcare program

Maintain customer service level of 98% or above

Assist Provider Relations and Marketing Representative in education new customers

Train new staff, assist in staff recruitment and interviewing process / Manage staff of 11 Education High School Graduate, Major in Math/Business, Graduated June 1984 Aragon High School, San Mateo, CA

Training: Knowledge of all Health Insurance Care

Plans(individual,group,state,federal,government programs) Completed Medical Terminology, Project Management and Presentation Skill Courses.

Experience in Creating/Implementing/Modifying SOP

Computers Microsoft Windows, Word, Excel, PowerPoint, Outlook

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