ROBIN JADA TORAN 443-***-****

EDUCATION

Central Texas College Associate Degree 4/1987

Delaware State College 98 Credits toward BS 6/1982-1986

Dundalk High School Academic Diploma 6/1982

EXPERIENCE

Robert Half Legal-Patient Financial Assistant/WFP

Assignment : AllianceRXWP March 2018 to Present

Responsibilities of a PFS Representative includes:

Processing New Patient/New Request for assistance and Existing Patient/New Request for assistance

Review medication(s) on referral and identify whether the patient’s insurance plan(s) is commercial or government funded; Consult the Zitter Health database to determine what, if any, program(s) the patient qualifies for; If PFS identifies that the patient is eligible for a specific assistance plan, review the program details; Explain the process, Turn around time (TAT), maximum benefit, if provided, and any other available information If additional funding is needed, research eligibility of applying for multiple programs.

With patient authorization, enroll eligible patients with manufacturer’s copay assistance.

Submit the request for assistance on behalf of the patient (when allowed by program).

Follow-up with the program on the status of approval every 2-4 business days depending on the program’s typical TAT. Advise patient of follow-up frequency

Provide the patient or physician’s office with information on how to continue or initiate

Follow-up with the patient and physician until the process initiation can be confirmed. After application submission has been confirmed, advise patient of frequency of follow-up.

Loading assistance, Set up adjudicated plans for Copay Credit Cards

Manufacturer Copay Assistance Cards

Non-Adjudicated plans utilize the PAP grant tab. Load information when initiating application, and update throughout the process.

If there is a change in application/eligibility status, and/or coverage has been determined, update appropriate fields in PAP grant tab and select the applicable status and sub-status within the tab

If no response received, we send a rescue letter to the patient and notify the physician via the Fax MDO Cancellation form. Submit for NoGo Approval

Notification of assistance approval or denial. If a patient has been approved for assistance, update the PAP grant tab with the appropriate outcome, or load the appropriate PAP pay plan. If patient notifies PFS of approval, contact the program to confirm and obtain details. Add assistance pay plan or document details in the PAP grant tab for non-adjudicated pay plans.

Enter the appropriate diagnosis code on medical history tab, and then select this code

under the insurance tab.

Load eligibility dates of approval under the PAP grant tab

activity to initiate re-enrollment process 30 days prior to the expiration date. Populate the billing data tab, document referral and, when applicable, update the PAP grant tab prior to completing the PFS stage.

When patient is on the phone and ready to schedule order, warm transfer to PCC.

If the patient does not wish to proceed, document the reason, pend the referral to NoGo and inform the MDO via phone.

Re-verification for co-pay assistance on reorder referrals Verify that co-pay assistance is still active. All refill orders with co-pay assistance need to be re-verified at the beginning of the calendar year.

Non-adjudicated assistance must be re-verified after IV completes the primary payer re-verification.

When verifying assistance dates and grant amount, ensure the information loaded on the PAP grant tab matches the information provided by the program.

Check the Accounts Receivable (AR) screen to ensure all orders are taken into account when determining whether or not patient has enough funding to cover the order.

Existing Patient/Renewal Request Re-enroll the patient in a manufacturer co-pay card or request additional funding through the assistance program.. For renewals that are not instant approval, follow-up with the assistance plan, the patient and the physician, set follow up frequency based upon Priority Chart

Route referrals to PFS stage for patients with assistance through a non-profit, no longer be receiving therapy from ARxWP Specialty and record the reason for discontinuation. For CDF, CCC or SSL, log on to the non-profit portal and submit an updated status. For all other non-profit organizations, call and notify the organization.

Creating/Applying a PAP Template and PAP Grant

Start the patient PAP template at the onset on the PAP outreach. Update application status and sub-status throughout the application process and enter all applicable information as received.

If there is not a referral in process, monitor the clinical activity work list and look at the patient images for approval.

Referrals or orders routed to PFS with an e-voucher attached Review primary claim information to determine how much the e-voucher paid on the claim.

Review account to determine whether the patient is also enrolled with a copay card through the manufacturer. If the copay card cannot be processed on top on an e-voucher, determine the best benefit for the patient.

If e-voucher needs to be removed, contact Relay Health

If a copay card is not loaded on the profile, quote benefit based upon the amount returned from the e-voucher.

Waiting for Payment:

Responsibilities include General Process – Non Major Medical Orders,Orders will route to WFP for the following situations: 1. Credit Issue 2. Card declines, 3. expired card, 4. over their limit, and 5.multiple cards to charge.

If the total on the order is more than the Total Authorized to Charge box. If the total on the order is $50 ($100 for CFS) or more and there is no amount entered in the Patient Payment Authorization Not to Exceeds box.

We will review all of the notes on the patient’s account and will make an outreach to the patient if resolution is needed.

If we are invoicing the patient’s order, the total of the order along with the patient’s AR balance cannot exceed $250 or be more than 120 days past due

ACS formally known as Omnicare /CVS

Omnicare 6251 Chancellor Drive, St. 101, Orlando, Fl 32809 May 2016 to February 2018

Billing Specialist/Collections/CATS/SPARCS

Responsibilities include Knowledge of Medicare, Medicaid, and Government Insurance, Benefits Verification, to run claims, to be knowledgeable in co-pay assistance programs adjudicating Claims and adjustments, prior authorizations, collections, cash adjustments, universal adjustment forms, speaking with patients, insurance providers, secondary insurance/co pay programs, knowledgeable of a variety of trial card programs

Collections Specialist duty was collection calls and/or correspondence in a fast paced goal oriented collections department.

Providing customer service regarding collection issues, process customer refunds, process and review account adjustments, resolve client discrepancies and short payments. Responsible for monitoring and maintaining assigned accounts- Customer calls, account adjustments, small balance write off, customer reconciliations

Accountable for reducing delinquency for assigned accounts.

Performs other assigned tasks and duties necessary for Accounts Receivable.

Management when necessary to accelerate the collection process.

Communicate & follow up effectively with customer accounts on a timely basis.

Establish and maintain effective and cooperative working relationships

Marchena and Graham, P.A 976 Lake Baldwin Lane Winter Park, Fl April 2015 to June 2015 (resigned)

Legal Secretary to 2 Attorneys

Responsibilities included handling of all correspondence, billing to clients and per diem for attorneys travelling.. Calendars, docketing, scheduling, preparation of trial documents, e-filing, litigation, government contracts. Scheduling of flight arrangements, upcoming events. All office duties that apply including the ordering of supplies.

Omnicare/ACS Pharmacy 6251 Chancellor Drive, Ste. 101 March 2012 to Jan. 2015

Orlando, Florida 32809 (through Robert Half Legal)

Patient Account Specialist/Customer Service Representative-ACS/Omnicare

Transferred departments and now handle 80 to 100 incoming calls daily to assist the patients and Health Institution with varied issues.

Work rejected real time claims with full utilization of label suppression. Manage prior authorization process, along with the Benefits Verifications with 48 hours follow-up. Work backlog of denied claims for resubmission. Other duties as assigned; Job duties may vary by location. Schedule delivery of specialty medication Copaxone for MS PTS, Oncology, wide variety of specialty medications counsel PTS accounts review, Customer service que. I have the Ability to work in a fast paced environment, handling both inbound and outbound calls. I am Organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines. I have excellent communication skills internal and external. I Plan and organize (prioritize) work assignments completing them with minimum supervision. I also Adhere to the service policy and principles of the company, and program guidelines set by the department. Communicate effectively and professionally with our program partners to assure the best possible service for our patients and partners. Knowledge of Medicare benefits, enrollments and LIS assistance and solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing.

Bell, Boyd & Lloyd LLC 1615 L Street, N.W., Suite 1200, Washington D.C. June 2008 – Nov. 2011

Legal Secretary for Three Attorneys – Merged with K&L Gates LLP

Litigation Secretary for a partner of Bell, Body and Lloyd, This partner deals a lot with discrimination and labor law, trade secrets, non-competition agreements and commercial litigation in various court systems. Work also with another Partner who specializes in Government Contracts and Construction Law; and the last attorney specializes in complex commercial litigation, with an emphasis on litigation and arbitration of construction claims, federal government contract appeals, insurance coverage disputes and antitrust litigation. I am a Litigation/Contracts and Anti-Trust Secretary. My responsibilities include OCR, PDF, and electronic filings, as well as working with Delta View, Star Time, Star Bill, legal key, Concordance, and I Pro. I docket entries for each attorney, keep track of pleadings binders, filings, correspondence (Chron files), dictation, scheduling depositions, meetings and maintaining each attorney’s calendar. Proofing documents, using the BBL system style codes for document production, check request, billing payments, assisting with preparing briefs, Schedule conferences in meeting room manager and answering each attorneys phone lines.

Robert Half Legal 1201 F Street, N.W., Suite 900, Washington, D.C. 20004 April 2008- March 2012

Legal Secretary

Responsibilities included Administrative duties/secretarial duties/legal secretary duties, available to do the job requested at short notice. I worked several different locations with this firm; such as Whiteford, Taylor & Preston and Bell, Boyd & Lloyd (hired perm).

ASSETS and QUALIFICATIONS

Notary Public

Result oriented professional, high energy, enthusiastic, outstanding verbal and written communication

Member of Delta Sigma Theta Sorority, Inc.

SKILLS

Type 85 wpm, Dictate 75 wpm, SATS, DTS, Excel, Word, Access, Power Point, Outlook, Speaks Tagalog and Spanish; Electronic Filing, PDF, OCR, Delta View, I-Scrub, Star Time and Star Billing, Legal Key, Meeting Room Manager, Right Fax, Lawyers Travel, and Style Codes, Payne Numbering System; Libris, IPRO, Concordance, Bates Label; Seamless Web Ordering, Docketing, Webview Time System, AT&T Conference Calling; Basic Trademark Experience; CPRX, Doc9000, IDX old/new, ICD-9, CPT 4 codes, Accounts Receivable in Medical or Pharmacy Industry, Processing Paper and/WEBMD claims, Private pay, insurance company’s collection in pharmacy, posting and reconciliation, CPR Plus, SPARCS, HBS, knowledge of Med A/B/C/D, Medigap/ Military Benefits, Benefits Verifications, Litigation, Prepare and Proof Briefs, Contracts, and Correspondences, various aspects of Law, Government, Anti-Trusts, commercial litigation, WCC, PI, Third Party/Negligence, Domestic and Criminal Law

REFERENCES: Furnished upon request.

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