Ana Delmy Escalante Martinez

• Responsible for new patient intake, benefits investigation, initiating prior authorizations, and navigating patient access for an assigned product program
• Responsible for the day-to-day customer service activities and support of assigned clients and customers
• Provides excellent customer service to all interaction
• Responsible for routing all incoming documentation for new patients, refills, and additional documentation for Specialty and Infusion pharmacies per product program requirements
• Responsible for prescription entry, requesting new prescriptions, and clarifications from prescribers as supervised by a pharmacist
• Must be able to complete benefits investigation, including prior authorization and medical vs pharmacy determination
• Responsible for navigating and troubleshooting all aspects of patient access to all patients within a dedicated product program
• Explains all Company programs and services to Referral sources and provider’s office staff regarding what to expect with Company services, contents of shipments, and patient rights
• Enters data requirements into tracking software
• Transfers call to clinical staff for clinical education/assessment activities
• Creates patient’s estimated cost of benefits with all pertinent information and attaches to record for use by customer care center of excellence
• Notifies appropriate staff of relevant information gathered during calls to providers or patients that may affect a patient’s disease state, medication regimen, or method of funding
• Records and processes orders and/or inquiries received by mail, telephone and/or through direct patient contact
• Maintains documentation of calls to and from patients, caregivers, insurance, providers, and Pharma
• Creates patient activities as a reminder for the following tasks, including, but not limited to, follow-up calls, clinical assessments, referrals to Case Management, discharge initiation, patient letters, mailings, or other reminders related to the patient’s care
• Collaborates with program team members on other aspects of the product program, not limited to intake and patient access functions and patient communications and onboarding
• Responsible for coordinating manufacturer or nursing agency support when home teaching is required
• Must maintain referral log daily and update with all pertinent information
• Responsible for completing patient’s Estimated Cost of Benefits and able to explain to patient and others in the organization
• Contacts referring nurses/coordinators according to the assigned team regarding insurance verification findings and patient issues, and status updates
• Adheres to all company policies as indicated in the handbook and directives issued by management
• Frequently interact with co-workers, intradepartmental staff of the Company, managers, leaders, Vendors, and customers

Make outbound and take inbound calls
• Communicate with Humana members
• Collect medication history information
• Prepare members for a comprehensive medication review

• Conducted thorough medication reviews to identify and resolve discrepancies, preventing potential errors.
• Promoted adherence to treatment regimens through targeted counseling sessions tailored to individual patient needs and preferences.

• Enhanced inventory accuracy by conducting regular cycle counts and reconciling discrepancies.
• Performed data entry and completed proper paperwork.
• Completed physical inventory counts each month.
• Collaborated with team members to ensure timely completion of daily tasks, increasing overall productivity.