Adrienne Wallace
Memphis,TN
Summary
A healthcare professional leader with 20+ years of experience specializing in medical and pharmacy reimbursement with purpose, integrity, and excellence. Stellar record of organizational performance, team building, coaching, motivating, and developing staffs of diverse backgrounds. Proven track record of leading with accountability, while providing tools and resources for organization growth and success.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Eligibility Manager
Express Script/Cigna
06.2021 - Current
- Provides leadership to the Oncology Patient Access team in the areas of Clearance, Ship Clearance, Prior Authorization and Re-Authorizations.
- Works closely with the Oncology TRC Director and Contact Center leaders to meet patient, prescriber, and client expectations.
- Engage with Product, Account Management, Service Delivery, Corporate Finance, and other cross-functional teams. Work with the Director to develop policies, procedures, and the business work plans for the patient access department.
- Support hiring, training, and evaluation of diverse staff.
- Develop employee’s skills, evaluate performance, provide feedback, and oversee resolution of employee relations.
- Develop, track, and monitor employee’s compliance to quality, service, quality, and professional issues.
- Monitor prescription turnaround time so that internal standards and client Hub performance guarantees are met.
- Implement programs and process improvements to enhance the level of internal and external customer service provided.
- Work with Pharmacy Director to analyze operations, overall efficiencies, and monitor costs to ensure compliance with cost to fill goals.
- Serve as a point of escalation for issues requiring a higher degree of expertise of discretion to resolve.
- Collaborate with senior manager on current and future IT initiatives as well as act as the department liaison for all IT requests, enhancements, UAT testing, and review of requirements/design documents.
- Represent pharmacy operations in cross-functional meetings and projects.
- Encourage and display active and ongoing engagement with team members, while promoting a positive and productive culture amongst team members.
- Other special projects and task as assigned.
Eligibility Supervisor
Express Script/Cigna
01.2019 - 06.2021
- Assisted with the development of short & long-term goals for department and plan of implementation to bring to completion for on-going success of department.
- Liaison for partners outside of Rare Disease, Account Team, Contact Center
- Ensured prompt communication regarding concerns or problem resolution occurs.
- Directed assigned team members in accordance with departmental management initiatives.
- Scheduled& facilitated routine staff meetings to communicate department/company processes and/or changes.
- Followed up with assigned coordinators to ensure policies and procedures are understood and compliant.
- Provided department leadership in the area of staff performance including mentoring, auditing, productivity monitoring and coaching for success.
- Corresponded with management on employee/HR issues, state of the department and any service issues involving key Hub clients or legal risk issues to the company.
- Analyzed reporting data trends within team relative to quality to ensure efficiency and productivity requirements are maximized to benefit patients.
- Provided feedback to team related to productivity and efficiency.
- Assisted team members to resolve patient concerns and handling escalated issues relative to insurance, copays, and shipment delays
- Monitored quality and volume through various reporting, random call monitoring and random case file audits.
- Analyzed data for building annual training program and preparing teaching plans for new hire training classes. Overseeing and monitoring processes to ensure application of delivery for progress and achievements.
- Trained on new therapies and quarterly training for implementation of new processes and procedures
- Analyzed and updated SOP processes
Supervisor Program Management
United BioSource Corporation
07.2017 - 01.2019
- Participated in interviewing prospective employees, evaluating current employees, and train employees as needed. Develops current employees and tracks their compliance to quality, service and production standards.
- Worked with (Sr.) Manager to develop and communication strategic business work plan goals
- Assisted with the analysis and writing of client Hub reports and other deliverables. Assist with presentation of program information to internal and external customers
- Handled escalated and unresolved issues that may require deviation from standard procedures or require extensive research for resolution.
- Received special management and client Hub recognition for effective team building, problem solving ability, mentoring, and coaching, which creates a positive environment where people are empowered to excel.
Lead Patient Service Coordinator III
United BioSource Corporation
11.2012 - 07.2017
- Provided knowledge and guidance of eligibility process for patients and providers, in order to make necessary updates to various internal systems required for enrollment through appropriate specialty pharmacies to ensure medication delivery.
- Served as first point of contact for internal clients and members during the enrollment process. Make outbound calls to members to gather Enrollment Data; analyze and process data accordingly. Handled inbound member calls and written correspondence regarding member eligibility. Made independent judgments in order to respond to complex or critical member issues.
- Worked collaboratively with Eligibility Systems Analysts, other Eligibility Associates, Eligibility Managers and Account Managers to provide seamless support.
- Identified and escalated repetitive questions and /or problems so that corrective action can be pursued and expedited.
- Maintained an accurate and complete documentation of all contracts. This continuously improves the process and reduces potential legal concerns or payouts. Completed other projects and additional duties as assigned.
- Special management recognition for managing a daily report to ensure all enrollments were process timely in an effort to meet the program Service Level Agreement (SLA).
Senior Patient Account Representative/Clearance Specialist
Accredo Health Group
07.2006 - 10.2012
- Acted as a liaison between patients, providers, and insurance carriers to resolve coverage questions, prior authorization, eligibility, billing inquires, and confirmation of delivery
- Provided superior customer service to customers, providers, and insurance carriers in an effort to expedite shipment delivery.
- Investigated eligibility, prior authorizations, referral, and affiliated insurance networks.
- Special management recognition for recognizing fraudulent claims and exceeding quality objectives
Education
Doctor of Ministry - Land, Food, and Faith Formation
Memphis Theological Seminary
Memphis, TN05.2023
Master of Health Administration - undefined
Capella University
05.2016
Bachelor of Science - Health Administration
University of Phoenix
07.2014
Skills
- Leadership and Mentorship
- Analytical and Problem Solving abilities
- Medical and Pharmacy Policy Interpretation
- Oncology, Rare Disease, and Multiple Therapeutic expertise
- Healthcare Claim and Coding Expertise
- Client Support Specialty expertise
- Training, Teaching, & Educational expertise
- Commitment to Diversity and Inclusion
- Curriculum development/Instructional Techniques expertise
- ICD-10/HCPCS Coding/Medical and Pharmacy Terminology expertise
Affiliations
Toastmasters International 2016
Certification
American Academy of Professional
Coders April 2019
Timeline
Eligibility Manager
Express Script/Cigna
06.2021 - Current
Eligibility Supervisor
Express Script/Cigna
01.2019 - 06.2021
Supervisor Program Management
United BioSource Corporation
07.2017 - 01.2019
Lead Patient Service Coordinator III
United BioSource Corporation
11.2012 - 07.2017
Senior Patient Account Representative/Clearance Specialist
Accredo Health Group
07.2006 - 10.2012
Doctor of Ministry - Land, Food, and Faith Formation
Memphis Theological Seminary
Master of Health Administration - undefined
Capella University
Bachelor of Science - Health Administration
University of Phoenix