Andrea Taylor
Maxor National Pharmacy Services, LLC
Florissant,MO
13
years of professional experience
Highly motivated and driven, possessing a strong desire to embrace new challenges and continuously grow both personally and professionally. Demonstrates a solid work ethic and adaptability, excelling in various environments and thriving in fast-paced settings. Exceptional interpersonal skills enable effective collaboration with colleagues, fostering strong professional relationships. Experienced in working independently, capable of quickly mastering new skills and consistently delivering high-quality results. Open to relocating anywhere in order to seize new opportunities and contribute expertise to a dynamic team.
Work History
Member Advocate
2 Years 11 Months- Receives inbound calls from members to answer questions regarding their pharmacy benefits
- Establish and maintain relationships with members to ensure all needs are met completely, promptly, and professionally
- and conveying genuine care and expertise in services to the members
- Providing information and resolving issues for the members, positively influencing their experience with our services, providing a sense of care for them & expertise in our services
- Being in a unique position to influence a positive customer experience by providing information & solving issues for the member
- Remote
Sr Reimbursement Rep/Insurance Specialist II
4 Months- Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices, and submit and obtain prior authorizations as required by payer; obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval
- Accurately enter and maintain data as required in client database and patient files and utilize the client database to monitor outstanding items on each client case file
- Ensure files are complete so team can determine the current status
- Participate in conference calls as needed with Client Sales Representatives, client management and physicians’ offices regarding status of cases, drug orders and status of alternative funding
- Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient
- Remote
Program Specialist II
2 Years 5 Months- Complete investigations and answer questions regarding insurance benefits, including information about coverage such as deductible, out-of-pocket costs, and co-payments
- Collaborate with patients and insurance companies to assist with, reimbursement issues, prior authorization denials, and appeals
- Assist with prior authorization and medical necessity processes, benefit verification and prior authorization assistance
- Enter orders, change orders, track shipments, and enter customer notes to complete customer/ consumer transactions
- Handled Various Commercial, Medicaid, and Medicare insurance patient accounts
- Remote
Patient Service Coordinator
1 Year 3 Months- Handled 80+ inbound/outbound patient, physician and physician advocate inquiries
- Entered patient prescriptions, refills, physician orders into system
- Maintained inquiry documentation, applications/mailers/orders/enrollment forms for new patients
- Reported any allergy, adverse events or duplicate therapy warnings to appropriate group
Benefit Coverage Review Specialist/Authorizations Representative
11 Months- Handled over 100+ inbound calls and written inquiries from pharmacists, doctors and members regarding Administrative Appeals for patient medications that have been denied by the patient's Health Plan
- Reviewed, requested and screened, based on benefit plan design, client specifics and clinical criteria
- Prioritized time-enabling technologies in support of the organization's productivity
- Knowledge of medical terminology, and ICD-9 codes
- Readjusted claims for pharmacy payments and processed insurance claims for reimbursement to the patients
Reimbursement Specialist
4 Months- Verified insurance benefits, obtained prior authorizations and reauthorizations
- Validated accurate billing information to ensure claims are paid for drug shipments
- Accurate documentation of payer information and patient status
- Daily communication with patients, payers and physician offices regarding program status and financial responsibility
- Worked with different types of insurance such as Medicare, Medicaid, commercial insurance
Career Sabbatical to Raise Child
2 Years- Initially left work to have my child, in the midst of becoming a new mother gained many useful skills and qualifications in my field
- Decided to go back to college to gain educational experience to go along with my current and future work experience
Education
Master’s certificate - Instructional Design and Technology
MBA - Public Administration
Master's - Business Administration
Bachelor's - Criminal Justice
Associate - Criminal Justice
Skills
Human Resources
Clerical Experience
Transcription
Microsoft Excel
Instructional Design
Conflict management
ICD-9
Epic
CPT Coding
Human Resources Management
Sales
Medical Records
Communication skills
ICD Coding
ICD-10
Medical Billing
Medical Scheduling INFORMATION
English
Medical Terminology
Employee Orientation
Insurance Verification
Curriculum Development
Microsoft Office
Benefits Administration
Anatomy Knowledge
Analysis skills
Willing to relocate: Anywhere
EMR Systems
Medical Coding
Learning Technology
Medical Office Experience
Customer service
Negotiation
Order Entry
Organizational skills
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Achieved [Result] by introducing [Software] for [Type] tasks.
Timeline
Member Advocate
Maxor National Pharmacy Services, LLC
09.2023 - CurrentRead More
Sr Reimbursement Rep/Insurance Specialist II
UBC/AbbVie
05.2023 - 09.2023Read More
Program Specialist II
EVERSANA
11.2020 - 04.2023Read More
Patient Service Coordinator
UBC
03.2017 - 06.2018Read More
Benefit Coverage Review Specialist/Authorizations Representative
Express Scripts
04.2016 - 03.2017Read More
Reimbursement Specialist
Express Scripts
12.2015 - 04.2016Read More
Career Sabbatical to Raise Child
Home
11.2013 - 11.2015Read More
University of Phoenix
Associate from Criminal Justice
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University of Phoenix
Bachelor's from Criminal Justice
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University of Phoenix
Master's from Business Administration
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University of Phoenix
MBA from Public Administration
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Full Sail University
Master’s certificate from Instructional Design and Technology
Read More