Customer Service Specialist Healthcare Data Entry & PHI Security
Resume:
Selma M. Fife
Glendale, Az *****
********@*******.***
Summary
With 20+ years of professional experience in data entry, benefit verification, prior authorization and reimbursement, mostly in the specialty pharmacy field
I am passionate about patient care to make a real impact on how the care is delivered
As a dedicated team player, I have the ability to comply with regulations and integrity with security obligations.
Honed my skills in different roles over the years, while maintaining confidentiality to help patients receive the services and care they need. Also to always provide empathy.
Ability to act in accordance with company’s Standard Operating Procedures
The ability to use my critical thinking, research, overall inbound and outbound communication, by providing support to physicians, vendors, patients, and different entities as needed.
Ability to work autonomously with medical records management.
Able to maintain productivity while working remotely, using discretion viewing patient data,
Ability to verify accuracy and completeness of data that needs to be to be added to patient files
A strong desire to learn new concepts and ideas that will aid in daily workflow and adhere to quality and production standards.
Ability to adhere to data privacy requirements. Always ensure patient privacy
Strong communication skills in collaborating with appropriate departments and customers
Ability to manage a high-risk role, due to sensitive PHI Data and ensure there is compliance with HIPAA regulations
Skills
Microsoft Office products, Office, Excel, Word, Teams
Approx, 26 wpm typing, proficient with 10 key
Call Center experience, inbound and outbound
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 of sensitive materials
Experienced in obtaining eligibility and benefits from insurance plans
Medical terminology knowledge
Professional Experience
CareMedix (Medix Healthcare)
Patient Access Advocate
11/17/25-12/11/25
6931 Arlington Rd
Bethesda, MD 20814
Outbound calls to patients to confirm assistance is still required for program enrollment
Confirm HCP and medication
Confirm insurance information
Confirm Foundation availability
Assist Rx -Remote
January 2025-July 2025
4500 W. 107th Street Overland Park, KS 66207
Case Manager
Supported patients and healthcare professionals in the navigation of submitting prior authorization for specialty medications.
Assisted with the data entry of legal documentation, attach to correct case in a timely manner.
Conduct benefit investigations for patients and identify coverage restrictions, if any.
Input of provider and/or patient requests into the proper tracking systems
Assist and provide patients with any other necessary questions related to obtaining specialized medications.
Synetics/Novartis Pharmaceuticals (Hybrid contract assignment)
July 2024 - October 2024
200 South Wacker Drive, Suite 3100 Chicago, IL 60606-5877
Coverage and Access Reimbursement Specialist
Responsible for providing support about insurance coverage for prescribed medicines
Located 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
Insight Global/United Bio Source-UBC (Remote contract assignment)
Nov 2022-May2024
Sr Reimbursement Specialist
2325 E. Camelback Rd Ste 800 Phoenix, Az 85016
Provided administrative support to physicians, patients, and specialty pharmacies.
Reviewed and evaluated pharmacy services request and medications to determine if prior authorization is required.
Maintained 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. Completed and tracked prior authorization across specialty medications.
Assisted with appeals and denials related to prior authorizations, working closely with healthcare providers and insurance companies to gather necessary information.
Accurately entered and maintained 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 and from providers and insurance companies to follow up on authorizations
Achieved a 95% authorization approval rate, improving patient access to necessary medications.
McKesson Corp/Cover My Meds/CMM
Feb 2020-Aug 2022
5601 E. Pima Rd, Scottsdale, Az 85250
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
5601 E. Pima Rd, Scottsdale, Az 85250
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
5601 E. Pima Rd, Scottsdale, Az 85250
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 investigations
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
Education
American InterContinental University-Degree - Schaumburg, IL Associate of Arts in Business Administration (AABA) 2011-2012
South Mountain High School - Phoenix, AZ Diploma 1974-1979. General Studies 3.0 GPA
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