DOROTHY A. HANEY

Carlsbad, CA ***** fidk41@r.postjobfree.com c 760-***-**** h 760-***-****

SUMMARY

Reimbursement Specialist with extensive experience in Insurance Verification, Case Management, Prior Authorization and Appeals. Strengths include handling complaints, prompt response, excellent follow up skills, managing conflict and developing strong client relations. Worked for fortune 500 healthcare management companies specializing in the Pharmaceutical and Biotech industries.

EXPERIENCE

SHIRE REGENERATIVE MEDICINE, INC. (FORMERLY ADVANCED BIOHEALING, INC.) La Jolla, CA- Regenerative Medicine and Living Cell Therapies - Diabetic patient focus

Reimbursement Associate (2011-2012)

• Initiated and coordinated insurance verifications, prior authorization and appeals, for physicians, hospitals, and ambulatory surgery centers, for the company product Dermagraft

• Researched product special billing rules and procedural reimbursement rates

• Relayed coordination of benefits between primary and secondary insurers including Medicaid, Medicare, private and commercial payers

• Answered technical reimbursement questions for providers, billing and coding staff, and sales representatives

• Coordinated responses and resolutions to issues with appropriate internal and external parties

CRC HEALTH GROUP, Carlsbad, CA- Medication Assisted Treatment Clinics

Medical Billing Specialist (2009-2011)

• Performed Appeals, Prior Authorization, Insurance Verifications

• Billed medical claims for 16 treatment clinics for more than 800 clients, 60+ insurance companies, using HCFA & UB04 claim forms

• Medical Claims Collector resulting in achieving monthly 100% goals

MCKESSON CORP., Scottsdale, AZ- Specialty Pharmacy Marketing Services Division

Sr. Reimbursement Case Specialist, Field Sales Partner (2006-2007)

• Instrumental in obtaining payer specific prior authorizations through rigorous appeals process for the Amgen client (Biotechnology) Patient Advocate Group in a multiple state territory

• Created a form improving the work flow between the Customer Care Unit and Clinical Call Center resulting in a smoother work flow and uninterrupted services to both internal and external customers

• Investigated all denied services with customers and reimbursement specialists

• Responded to all provider and internal requests in a timely fashion

• Provided diligent follow-up to “win back” a disgruntled customer

• Partnered with field Sales Team providing Top Quality Management

• Heavy phone communication with multiple payer types conducting insurance verifications and benefit investigations

Dorothy Haney fidk41@r.postjobfree.com Page Two

CAREMARK (FORMERLY PCS, ELI LILLY), Scottsdale, AZ (1995-2006)

Client – Retail Pharmacy Program for Federal Retiree and active members – Pharmaceutical Benefit Manager (5 million members)

Prior Authorization Appeal Liaison, Blue Cross Blue Shield Reconsideration Liaison, Sr. Customer Care Team Lead Associate

• Suggested a plan letter which was presented to the Federal Employee Program at their quarterly meeting as a “quality initiative”. This suggestion led to both the Prior Authorization Clinical Services Department and the Medco Mail Order program updating their form letters, resulting in significant value to the client, saving time and money, while allowing a continuity of critical care to the Federal Employee patient

• Alerted the FEP MQA dept. to an extremely high utilizer of an addictive drug. This member utilized >$75,000 of this medication over a 2 year period. The abuse case was referred to the FEP Director’s Office for further investigation, providing top notch anti-fraud efforts, patient quality and safety, which was a major objective of the MQA department

• Supported escalated calls to 150 plus employees with technical plan benefit expertise

• BCBS Plan Liaison for Federal Government Office of Personnel Management, FEP Director’s Office, and Account Management Teams

• Dissolved customer complaints providing first line support to the Retail Pharmacy Program Blue Cross Blue Shield plans (52+) throughout the United States

• Trained and mentored over 1,000 Customer Care Representatives, launching yearly insurance selection projects, resulting in 100% accuracy of Government audits

• Provided exceptional customer service to 5 million FEP members regarding the interpretation of grievance and appeals procedures, plan benefits, utilization policies, enrollment, claim adjudication issues, and complaints

• Prior Authorization liaison between the Customer Care Unit (100) and 5 million members including the Prior Authorization Patient Safety Quality Monitoring Clinical Program Team of Pharmacists and their clinical staff (40)

• SMITHKLINE BEECHAM PLC., Fullerton, CA (1992-1994)

Critical Care Diagnostic Laboratory Instrumentation

Field Service Engineer Coordinator

• Prioritized approximately 40 emergency field service calls per hour, for 6 east coast states

• Collaborated with outside Field Sales Management Teams, Field Engineers, Universities, Special Serology laboratories and critical care hospitals

ADDITIONAL RELEVANT EXPERIENCE- CERTIFICATIONS- EDUCATION

• Mayo Hospital, Pharmacy Department

• CpHT Certified Pharmacy Technician

• CPC-H Certified Professional Coder Hospital

• Mount San Antonio Community College, Walnut, CA (completed 25 credits)

• Arizona College of Allied Health for Pharmacy Technician Training

• 90 wpm, MS Office

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