Support Specialist Customer
Resume:
Yolanda Harris, Provider Relations Analyst
Contact
Yolanda Harris
*****.*********@*****.***
Objective
To obtain a position within an organization to provide forward thinking and to demonstrate an ability to think analytically, collaboratively with physicians and office team to provide strong reimbursement and Patient access support that translates into favorable outcomes. Education
11/2012
B.S. Organizational Management;
Bethel University - Memphis, TN
09/2010, 05 /2015
Certificate of Completion
Medical Billing and Coding ICD
9 & 10; Messick Vocational
School - Memphis, TN
Key Skills
Reimbursement and Access
(20+ years)
Market Access (20+ years)
Bio Pharmaceutical / Medical
(10+ years)
Collaboration with Matrix
Partners
Relationship building
Financial Accounting
Microsoft Office
Multiple EHR systems
Communication
Macro User, excel, word,
webex
ICD 9
ICD 10
Experience
01/2022 TO PRESENT
Provider Relations Analyst • Accredo Specialty Pharmacy Key liaison between Accredo and prescribers, through development of strong, positive working relationships, both internally and externally
• Work closely with Accredo’s Physician Engagement Team to drive forward the goal of ensuring a positive Accredo experience by the prescribers and enhance relationship between the MDO and Accredo pharmacy
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• Understand and communicate details presented in the inquiries and investigations, to drive an immediate and successful resolution.
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• Interpret claims information and billing procedures, and assist the provider with any claim processing issues. Provide follow-up on incoming inquiries via internal IM chats, phone, and email. Problem-solve to ensure exceptional customer service. 11/2020 TO 01/2022
Customer Support Specialist • Prospero Health, Palliative Care
• Maintain customer accounts and records of customer interactions with details of inquiries, complaints, or comments.
• Answer questions to assist patients with getting the most out of their insurance for home health care.
• Manage referrals from patients, family members and providers for patient enrollments.
• Perform benefit investigation for at home Durable medical equipment
• Support scheduling of patient visits, including coordination of rescheduled follow-up appointments that align with clinician and patient availability
• Made outbound calls to inform patient of new benefit offered through Medicare health plan and enroll patient for service. 02/18 TO 11/2020
Precertification Specialist • Semmes-Murphey Neurosurgery Clinic Brain and Spine
• Obtain precertification for surgery cases based on plan guidelines including spine fusion and dorsal column stimulator trial/permanent placement and stereotactic radiosurgery.
• Review denial letters for appeal requirements and submit appeal requests to plans based on denial rationale.
• Inform nurse staff of upcoming changes that would affect a patient in having procedures.
• Verify insurance eligibility and benefits via phone and/or internet access.
• Communicate regularly with facilities in which procedures will be performed.
• Notify primary care physician for managed care plans that require PCP authorization.
• Supply patients with written or verbal estimates of surgical codes and fees upon request.
• Meet with patients pre-operatively to communicate and confirm their understanding of the billing process and their financial expectations.
• Notify patients with past due accounts of pre-payment policy for elective surgery.
• Receive payments from patients
02/2018 TO 10/18 • Company Layoff
11/2012 TO 01/2018
Case Manager • United BioSource
• Served as the drug manufacturer’s primary point of contact for physician offices, specialty pharmacies, and sales partners.
• Assist physician offices with resolving complex coverage and reimbursement issues to prevent/resolve barriers to access for patients prescribed specialty medications.
• Educate sites on proper, billing, coding, and product resources.
• Subject matter expert on national and state insurance plans.
• Reviewed payer contracts to identify types of plan and acceptability of reimbursement rates.
• Directly educated accounts and coordinate patient support programs such as Patient assistance program(PAP)
• Partner with Account Executives, Team Leads on coverage related issues identifying policy changes affecting patient access to therapy with monthly meetings
• Maintained / nurtured relationships with physician office staff through weekly meetings that involved patient treatment journeys.
• Support patient access by understanding the reimbursement journey within different business models and payers to identify potential reimbursement barriers or issues and provide
• Assist with determining coverage and access options available for a drug medication
• Understanding of buy and bill process, specialty pharmacy and prescription benefit models.
• Researched claim filing requirements and processed pharmacy claims.
01/2005 TO 11/2012
Insurance Verification / Admissions Dept / ER • Baptist Memorial Hospital
• Verified patients’ benefits with the members’ health plan and obtained prior authorization requirements for scheduled and ER visit and appointments.
• Informed patients of their financial responsibility for services rendered by the hospital.
• Verified insurance per member plan and collect money according to member benefit and hospital policy.
• Educate patient and office staff on Financial Support Services to offset out of pocket cost of procedure
01/2004 TO 01/2005
Unit Coordinator, Med Surgical • Baptist Memorial Hospital Performed administrative and clerical duties to include responding to patients' inquiries and concerns, schedule appointments / tests / labs, sort medical records, verifying insurance details, and assisting the physician on the care plans and patients' activities per MD orders. 09/1999 TO 01/2004
Administrative Secretary •Regional One Hospital
• Served as assistant to the Director and Medical Director of the Medplex.
• Worked on various projects for hospital business including researching opportunities for grants and contract writing.
• Maintained formal documentation for hospital compliance initiatives.
• Completed and analyzed reports for budget and hospital compliance.
• Scheduled meetings, recorded and disseminated meeting minutes to appropriate stakeholders.
• Scheduled flight for out of town business for Management
• Collected and reconciled cash collections from satellite clinics.
• Posted cash received receipts and adjustment requests and explanations as identified.
• Informed clinic managers and physicians on new policies and procedures to meet Medplex Clinic compliance with JACHO and OSHA administrations
Looking to change my career path for future growth potential and new challenges. I feel my skills and experience align into this new career as Field reimbursement Manager and will transfer well. I am a well-rounded professional with 20 plus years’ experience with direct/ indirect patient care, Medical, private office, surgical, hospital, biopharmaceutical, Neurology, OBGYN, DME, Endocrine and growth hormone reimbursement support. Subject matter expert on national and state insurance plans and able to communicate with MDO and staff. I have a sincere passion to help others and able to learn new skills quickly
References
[Available upon request.]
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