Verification Specialist Data Entry

Sandra Allen

T: 407-***-****

E: **************@*****.***

Management Skills

●Teambuilding and Leadership

●Customer Relations

●Staff Training and Development

●Customer Service Excellence

●Complaint Resolution

Professional Experience

Patient Access Coordinator/Liaison - Kroger Specialty Pharmacy (Formerly Axium Healthcare)

Lake Mary, FL — 02/2015- Present

Maintaining good housekeeping techniques, adhering to quality

and production standards and comply with all applicable company,

Completing a full analysis of the prescription denials. Working as a liaison with (Anthem BCBS) and department supervisors to ensure submitting accurate and necessary clinical information.

Experience in maintaining state, and federal safety and environmental programs, and procedures.

Performing benefit investigations, verify insurance benefits for patient and physicians’ office, and submit and obtain prior authorization.

Maintaining/Updating records per management direction.

Closely working with Manager to assist with leadership of team and being readily available for any questions and assistance with understanding any policies or guidelines regarding quality of work, time and compliance.

Assisting with Business Analytical Data

Insurance Verification Specialist - (Express Scripts)

Lake Mary, FL — 2013 – 2015

Conduct benefit investigations, verify insurance benefits for patient and physicians’ office, and submit and obtain prior authorization, 1st and 2nd level appeals as required by payer.

Participate in calls with Client Sales Representatives/client management and Physicians’ offices regarding status of cases, drug orders and status of alternative funding.

Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient. triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies.

Serving as single point of contact for an assigned group of prescribers within a region and identifying and reporting events as required by the REMS requirements for specified medication.

Provided a role as Interim lead with background as a SME (Subject Matter Expert) assisting those currently and new to the team.

Manager (Patient Services) - AcariaHealth

Orlando, FL — 2012 – 2013

Manage insurance representatives, patient care coordinators, indexers, and intake prep representatives’ daily functions.

Provide ongoing process training, develop standard operating procedures, job aids, and provide assistance with designing and updating internal process flows along with developing standard operating procedures (SOP) to accommodate new incoming specialty drugs

Duties included but not limited to assigning daily work to the specific representatives roles; and other duties as assigned.

Supervisor (Customer Service) – Aetna Specialty Pharmacy

Orlando, FL — 2013 – 2015

Supervisor of two team; Indexing (RX data entry) and Patient Care Coordinators; and have also supervised the Infertility team.

Functions were to facilitate daily process flows, develop learning tools, address and resolve issues as they arise.

Manage work queues, team’s productivity metrics, manage department’s PTO calendar, and other duties as assigned by senior leadership team.

Education

Everest University

MBA in Business Administration/Human Resource Management

Florida Metropolitan University/Orlando College

Bachelor of Science Degree in Business Administration/Marketing

Marymount Manhattan College

Candidate in Administration Career Transferred

Hostos Community College

Dental Hygiene Course

References

Available upon request.

Contact this candidate