Remote Patient Access & Reimbursement Specialist

Terika Taylor

Winston-Salem, NC *****

318-***-**** **************@*****.***

Open to Remote Opportunities & Relocation

PROFESSIONAL SUMMARY

Results-driven Remote Patient Access and Reimbursement Specialist with 6+ years of experience supporting prior authorizations, benefits verification, reimbursement resolution, and specialty pharmacy workflows within the healthcare industry. Skilled in navigating commercial, Medicare, and Medicaid insurance plans while coordinating with patients, providers, pharmacies, and insurance payers to ensure timely access to treatment and medication support services.

Proficient in Salesforce CRM, CoverMyMeds (CMM), Genesys Cloud, Five9, CloudScript, CareMetx Digital Hub, PX Connect, Microsoft Excel, Outlook, and HIPAA-compliant documentation systems. Recognized for strong communication, denial resolution, problem-solving, and remote workflow management in fast-paced healthcare environments.

CORE COMPETENCIES

• Prior Authorization Management

• Benefits Verification & Investigation

• Insurance Eligibility Verification

• Appeals & Denial Resolution

• Specialty Pharmacy Support

• Patient Access Coordination

• Reimbursement Support

• HIPAA Compliance

• Salesforce CRM

• CoverMyMeds (CMM)

• Genesys Cloud

• Five9 Dialer System

• CloudScript

• CareMetx Digital Hub

• PX Connect

• Microsoft Excel

• Outlook

• Cross-Functional Communication

• Workflow & Case Management

• Data Entry & Documentation

PROFESSIONAL EXPERIENCE

Remote Patient Access & Prior Authorization Specialist

Occam Health Remote

November 2025 – April 2026

• Managed prior authorization workflows for specialty medications and treatment approvals across commercial, Medicare, and Medicaid insurance plans.

• Conducted comprehensive benefit investigations to verify patient eligibility, coverage limitations, copay responsibilities, and reimbursement requirements.

• Utilized Salesforce CRM, CoverMyMeds (CMM), Genesys Cloud, CloudScript, Outlook, and internal hub systems to document patient cases and track authorization outcomes.

• Coordinated communication between patients, healthcare providers, specialty pharmacies, and insurance payers to resolve authorization barriers and support continuity of care.

• Assisted with appeals, denial resolution, and payer follow-up to improve patient access to prescribed therapies.

• Maintained HIPAA-compliant documentation while managing high-volume remote workflows and case tracking.

• Provided reimbursement support, status updates, and guidance regarding medication access programs and insurance processes.

Medical Reimbursement Specialist

Peace of Mind LLC Charlotte, NC

June 2024 – January 2025

• Verified patient benefit payments and reimbursement accuracy according to insurance policy guidelines and healthcare compliance standards.

• Utilized SimplePractice to confirm patient enrollment for ePrescribe services and assist with medication management support.

• Tracked reimbursement information, claim updates, and patient-related data using Microsoft Excel.

• Collaborated with healthcare providers and insurance companies to verify coverage, submit claims, and resolve reimbursement issues.

• Assisted with denial mitigation, appeals coordination, and patient communication regarding coverage updates and next steps.

Medical Benefits Specialist

CareMetx / TalentBridge Remote

December 2023 – January 2025

• Monitored patient benefits enrollment and tracked insurance policy changes utilizing the CareMetx Digital Hub.

• Utilized PX Connect to verify patient data, authorization requests, benefit investigations, and status updates.

• Resolved benefit-related inquiries and discrepancies through communication with patients, healthcare providers, and insurance companies.

• Collaborated with cross-functional teams to streamline benefit verification and authorization procedures.

• Assisted with onboarding and training support by sharing workflow knowledge and benefits management best practices.

Medical Reimbursement Specialist

Lash Group Fort Mill, SC

November 2019 – May 2021

• Obtained and verified insurance and billing information to ensure accuracy before discussing sensitive patient coverage details.

• Supported reimbursement processes and coordinated with patients and healthcare providers regarding insurance-related inquiries.

• Maintained professional and HIPAA-compliant communication while assisting with patient support workflows.

• Collaborated with team members to support patient access and reimbursement operations.

Independent Wellness Practitioner (Contract)

Patterson Psych Group, PLLC Remote

2019 – March 2026

• Provided client-centered wellness sessions focused on relaxation support, stress reduction, and holistic wellness practices.

• Maintained professional client communication, appointment scheduling, and confidential session documentation.

• Managed remote session coordination while maintaining a compassionate and client-focused environment.

• Built strong interpersonal communication skills through one-on-one client support and wellness-based services.

EDUCATION

Southern New Hampshire University

Accounting Coursework

2020 – 2022

TECHNICAL SKILLS

Salesforce CRM CoverMyMeds (CMM) Genesys Cloud Five9 CloudScript CareMetx Digital Hub PX Connect Microsoft Excel Outlook SimplePractice HIPAA Compliance Prior Authorizations Benefits Verification Insurance Eligibility Appeals & Denials Specialty Pharmacy Support Data Entry Remote Documentation Systems Case Management Patient Communication

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