Alexander Silva
Inglewood,CA
Summary
Highly motivated Reimbursement Specialist at UCLA Hematology & Oncology with 16 years of healthcare experience. I have over 5 years of experience as a Reimbursement Specialist. In this role, I am responsible for overseeing the reimbursement process for my organization. This includes working with insurance companies, physicians, authorization management and billing management to ensure the correct reimbursement for services. I also work closely with leadership to make sure that all of our institution financial goals are being met. With the dedication and experience in my role I have helped reach our financial goals with minimal loss of revenue. Seeking an opportunity to join an organization as a Reimbursement Manager where I can use my expertise in healthcare reimbursement and financial management to help drive success.
Overview
6
6
years of professional experience
Work History
Reimbursement Specialist
UCLA Health
10.2019 - Current
- Streamlined reimbursement processes by implementing efficient filing and tracking systems.
- Improved departmental accuracy through meticulous attention to detail while reviewing claims submissions.
- Ensured timely payment of claims by promptly addressing and resolving any discrepancies or issues with billing team.
- Assisted patients with understanding their benefits coverage, providing clear explanations regarding out-of-pocket expenses and reimbursements.
- Collaborated with cross-functional teams to develop strategies for maximizing revenue recovery efforts.
- Reduced claim denial rates by thoroughly reviewing documentation for medical necessity before submission to insurance providers.
- Identified trends in reimbursement denials, recommending process improvements to minimize future occurrences.
- Developed a reputation for expertise in handling complex reimbursement cases, becoming a go-to resource within the team for assistance in problem-solving difficult scenarios.
- Followed up on denied and unpaid claims to resolve problems and obtain payments.
- Contributed to increased team productivity by consistently meeting or exceeding individual processing goals.
- Assist closely in the process of obtaining drugs through specialty pharmacy or buy and bill.
- Extensive understanding on FDA indications, Medical Policies and NCCN Compendium Guidelines for proper drug reimbursement.
- Knowledge of benefit verifications & prior authorization/pre-determination requirements (including appeals/exceptions), & knowledge of access & reimbursement processes.
- Experience in working with patient assistance programs to obtain assistance when payors have denied treatments or leaving patients with a high out of pocket cost.
- Educate applicable clinic staff and maintain information regarding patient financial support programs
- Function as a liaison between the hem/onc community practices, authorizations, and billing office to answer reimbursement questions.
- Assist with patient cash quotes and Medicare 20% coinsurance estimates.
- Work with Authorization Manager and assist with tracking authorization denials by creating and maintaining a quality improvement excel spreadsheet.
- Assist with the Authorizations DOM AUTH Team Work Queue and Coding Work Queue.
- Assisted in the Workflow Process for Specialty Drug Referrals.
- Knowledge of oncology CPT and ICD-10 codes and medical office procedures. General knowledge of oncology procedures and terminology.
- Working knowledge of insurance authorizations and verification process for major medical insurance plans.
- Skills in analyzing information, problems, situations, practices and procedures to recognize alternatives and provide solutions while maintaining cooperative working relationships with administrators, physicians, peers and the public.
- Knowledge of State and Federal programs to ensure reimbursement from Medicare, Medi-Cal, or other sponsoring agencies as well ask knowledge of reimbursement guidelines for commercial and managed care payers.
- Knowledge in the functional operations of third party payors and utilization review agencies to expeditiously coordinate follow-up.
Copay Assistance Coordinator
UCLA Health
06.2018 - 10.2019
- Responsible for coordinating copayment enrollment and claims assistance for all community practice therapeutics. In addition providing patients with drug assistance program information and optimize reimbursement for cancer and specialty therapies by ensuring that FDA guidelines and off-label compendia listings are properly observed for insurance reimbursement.
- Created and developed workflows for our free drug program when insurance denied treatments or patients couldn't afford out of pocket cost.
- Research and develop access/reimbursement procedures and protocols for medication and copay recovery, resulting in increased patient access to medications.
- Monthly meetings with pharmaceutical representatives to discuss program updates or improvements to make patient assistance better for patients.
- Assisted with the creation of the Copay Program at UCLA and constantly creating new ideas to make the program better.
- Responsible for enrolling patients into various reimbursement programs resulting in over $2 million in savings annually.
- Assisted with administrating grant funds, including allocating program funds to direct recipients, tracking fund balances and reporting financial progress.
Education
Certification in HVAC - HVAC Installation And Repair
Los Angeles Trade Technical College
Los Angeles, CA06.2007
Skills
- Microsoft Office
- HIPAA Compliance
- Medicare Knowledge
- Eligibility Verification
- Medical Billing
- Copay Collection
- Claims Processing
- Payment Posting
- Commercial Insurance
- Healthcare Industry
- Financial Analysis
- Training and Development
- Strategic Planning
- HCPCS Coding
- Interpersonal Skills
- Problem Solving
- Medical Terminology
- Organizational Skills
- Quality Assurance
- Time Management
- Appeals Handling
- Conflict Resolution
- Customer Service
- Administrative Support
- Payment Processing
- Word Processing
- Revenue Forecasting
- Presentation Skills
- Team Collaboration
Accomplishments
I have received STAR Awards in my organization the last couple years for being able to meet performance standards.
Timeline
Reimbursement Specialist
UCLA Health
10.2019 - Current
Copay Assistance Coordinator
UCLA Health
06.2018 - 10.2019
Certification in HVAC - HVAC Installation And Repair
Los Angeles Trade Technical College