Insurance Prior Auth Verification Reimbursement Customer Service
Resume:
Selma M. Fife
Glendale, Az *****
********@*******.***
Summary
With over 20+ years of professional experience in benefit verification, prior authorization and reimbursement in the pharmacy and healthcare field.
As a dedicated team player, I have honed my skills in different roles over the years, with the willingness to learn new concepts
The ability to use my critical thinking, research, overall inbound and outbound communication, by providing support to physicians, vendors, patients, and different departments
Able to maintain productivity while working remotely
Education
American InterContinental University-Degree - Schaumburg, IL Associate of Arts in Business Administration (AABA) 2013
South Mountain High School - Phoenix, AZ Diploma 1979
Skills
Microsoft Office: Word, Excel, Data Entry
31 wpm typing, proficient with 10 key
Call Center experience, inbound and outbound
Maintain patient confidentially of sensitive materials
Skilled with the ability to collaborate remotely using MS teams with a secure working environment
Particularly good verbal and written communication skills and attention to detail
Knowledge of Commercial, Medicare, Medicaid and Military insurances
Knowledge of Sales Force, Five 9, Genesys operating systems
Familiar with Change Healthcare and other EMR systems and CMS
Ability to follow company policies and procedures, and maintain patient confidentiality
Experienced in obtaining eligibility and benefits from insurance plans
Medical terminology knowledge
Professional Experience
Synetics/Novartis Pharmaceuticals (Hybrid contract assignment)
July 2024 - October 2024
Coverage and Access Reimbursement Specialist
Responsible for providing support about insurance coverage for prescribed medicines
Locate patient insurance coverage, and any other requirements using reimbursement tools and collaborating with payers and providers.
Prepared proper documentation and notifications, performed proper escalation, tracking, and follow-up
Shared appropriate information with Patient Specialty Services field teams.
Managed outbound calls to providers and insurance companies (30+ calls per day)
Insight Global/United Bio Source-UBC (Remote contract assignment)
Nov 2022-May2024
Sr Reimbursement Specialist
Provided administrative support to physicians, patients, and specialty pharmacies.
Reviewed and evaluated pharmacy services request and medications to determine if prior authorization is required.
Maintain accurate and organized records of all authorization requests, follow up activities and outcomes in order to meet SLA deadlines
Obtain proper authorization and identification prior to release of confidential medical records. Complete and track prior authorization across specialty medications.
Assist with appeals and denials related to prior authorizations, working closely with healthcare providers and insurance companies to gather necessary information.
Accurately enter and maintain data as required in client database and patient files, utilize the client database to monitor outstanding items on each client case file.
Participated in Call Center Activities, triaged and responded to incoming calls from patients, insurance companies, physicians, Sales Reps, Pharmacies.
Educated patients, prescribers, regarding program requirements, as well as troubleshooting manufacture co-pay card issues.
Maintained good housekeeping techniques, adhering to quality and production standards
Complied with all applicable company, state, and federal, safety environmental programs and procedures
Successfully handled both inbound & outbound calls to providers, insurance companies (50+ calls per day)
McKesson Corp/Cover My Meds/CMM
Feb 2020-Aug 2022
Sr Health Services Associate
Made outbound calls to pharmacies, (local and specialty) and insurance plans to obtain updates on prior authorizations submitted for specialty medications.
Ensured accuracy of information obtained is properly into the appropriate systems with correct next steps to complete the authorization process.
Confirmed correct insurance was on file for claim submissions
Complied with all applicable company, state, and federal, safety environmental programs and procedures
McKesson - Scottsdale, AZ
Dec 2013-Feb 2020
Reimbursement Specialist III
Provided product specific reimbursement support to patients, healthcare providers, patient advocates, and manufacture representatives
Ran daily field reports, calculated total of cases for specific regions and reported to management.
Ensured intake information was accurate and complete to perform all reimbursement research.
Interacted via telephone with Commercial, Medicaid, and Medicare payers to conduct insurance verifications and benefit investigation
Worked daily with Commercial, Medicare, and Medicaid payers to ensure appropriate coverage and reimbursement in a variety of therapeutic areas
Improved upon knowledge of insurance plans requirements in an effort to obtain detailed benefit information and maximize plan benefits
Utilized internal resources to identify and provide alternate funding sources for patients without insurance or adequate coverage through their insurer
Obtained payer specific prior authorization procedures and documentation requirements, if applicable, and facilitate the prior authorization process for patients and healthcare providers
Assisted as a SME for 2016 Blizzard season
Handled outbound calls to providers, insurance companies (40+ calls per day )
McKesson - Scottsdale, AZ
Jan 2013 - Sept 2013
Reimbursement Specialist II
Provided product specific reimbursement support to patients, healthcare providers, patient advocates, and manufacture representatives
Ensured intake information was accurate and complete to perform all reimbursement research.
Interacted via telephone with commercial, Medicare and Medicaid payers to conduct insurance verifications and benefit investigation
Collaborated daily with all payer types to ensure appropriate coverage and reimbursement in a variety of therapeutic areas
Improved knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize plan benefits
Utilized internal resources to identify and provide alternate funding sources for patients without insurance or adequate coverage through their insurance
Obtained payer specific prior authorization procedures and documentation requirements, if applicable, and facilitated the prior authorization process for patients and healthcare providers
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