Antonio A Ferretti Neto
Orlando,FL
Summary
Compassionate Case Manager recognized for exceptional productivity and efficiency in task execution. Specialized in needs assessment, care plan development, and client advocacy. Strong communication, problem-solving, and time management skills utilized to support clients in achieving wellness objectives. Extensive experience in Specialty Pharmacy operations.
Overview
19
19
years of professional experience
Work History
Reimbursement Case Manager - Verona Patheway Plus
Caremetx
10.2023 - Current
- I act as a single point of contact and voice for all providers and patients. Works as a patient advocate.
- Coordinates access to therapies, conducts appropriate follow-up, and facilitates access to appropriate support services.
- Manages case load depending on the parameters of the program.
- Collect and review all patient information to the degree authorized by the SOP of the program.
- Guide the physician office staff and patients on how to complete and submit all necessary program applications promptly.
Reimbursement Specialist
Eversense Benefits Support Program
04.2023 - 10.2023
- On 10/27/2023, I started on the Eversense Benefits Support Program to launch this new program.
- Verification of Benefits.
- Inbound calls from the client.
- Receive and review faxes with the enrollment form and chart notes, and add them to our program.
- Provide detailed reimbursement information to the client.
- Works as a patient advocate, and always demonstrates compassion.
- Coordinates access to therapies, and conducts appropriate follow-up.
- Manages case load depending on the parameters of the program.
- Extensive knowledge of HIPAA regulations, and follows all company policies.
- Performs reimbursement-related activities, such as benefit investigations and prior authorizations.
Reimbursement Specialist
Appelis Assist Program
10.2022 - 04.2023
- I was part of the Appelis Assist Program launch.
- Verification of benefits, prior authorization requirements, and pre-determination requirements.
- Copay assistance and Patient Assistance Program screening.
- Managing financial and medical records.
- Collect and review all patient insurance information needed to complete the benefit verification.
- I have assisted the supervisors in special projects.
- Shadow new hires, and provide feedback and best practices.
Prior Authorization and Appeal Specialist
Kroger Specialty Pharmacy
Orlando, Florida
07.2016 - 10.2022
- Appeals (first and second levels).
- Act as a single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives, and other external stakeholders.
- Assess and refer patients appropriately for special programs and services when appropriate.
- Troubleshoot complex cases, spanning multiple disease states, while interfacing with key stakeholders (internal/external) to ensure an optimal start to therapy.
- Report adverse drug events that have been experienced by the patient in accordance with pharmaceutical requirements.
- Update the Hub site with current information (PA/appeal submission).
- Benefits verification.
- Prior authorization.
- Assisting with inbound and outbound calls.
- Work with patients to process prescriptions, refills, access benefits, apply charges against co-pay cards, and build customer relationships.
- Investigate and verify the benefits for pharmacy and medical plans.
- Assist patients with copay card enrollment.
- Prior authorizations: initiating requests, as well as following up and expediting responses from insurance carriers, other payers, and keeping the customer informed.
- Track, report, and escalate service issues for requests for authorizations, financial assistance, or other issues, ensuring timely patient access.
- Schedule the delivery of pharmaceuticals to patients.
- Relay clinical inquiries to either the pharmacy or the nursing team. Also, identify opportunities for counseling, and make referrals as needed.
- Maintain effective business relationships with doctors treating specific disease states, and relay specific case-related information as needed.
- Assist other departments with insurance verifications, welcome calls (explain our services, transfer prescriptions to other pharmacies, offer hub services, and transfer to another department if needed).
Patient Care Coordinator – PA and BI Coordinator
PRIME THERAPEUTICS SPECIALTY PHARMACY
Orlando, Florida
01.2014 - 07.2016
- Point of contact for the medication, Ampyra.
- Insurance verification.
- Prior authorization and benefit verification.
- Assisting with inbound and outbound handling of calls from and to members, manufacturers, doctors' offices, and insurance companies.
- Following up on emails received from the pharmacists and pharmacy techs.
- Updating spreadsheets for the team and the manufacturer to see our progress.
- Pulling the work-in-progress list and organizing the spreadsheet.
Patient Care Coordinator (User Holds)
CURASCRIPT SPECIALTY PHARMACY
Orlando, Florida
05.2006 - 01.2014
- As an offline coordinator, I am responsible for auditing patient prescription orders to ensure demographics are obtained and entered correctly by Patient Care Coordinators and insurance for specific medications from an interdepartmental work list.
- In addition to my primary responsibilities as a Patient Care Coordinator, I compile various reports to be distributed to management and agents to ensure the expeditious processing of highly sensitive medications.
- In this role, I am also responsible for obtaining special verification for specific medications, prior authorizations, and eligibility checks with insurance.
- Achievements – Assigned to multiple special teams formed to help maintain a positive relationship with key clients, and to adhere to contractual agreements.
Patient Care Coordinator (Patient Care Contact Center)
CURASCRIPT SPECIALTY PHARMACY
Orlando, Florida
05.2006 - 01.2014
- Handle customer service inquiries from members, providers, physicians, and internal clients related to pharmacy benefits. Work to research and resolve problems in a timely manner.
- Assist members in understanding and maximizing the use of their pharmacy distribution program.
- Use a computerized system to gather information and respond to questions.
- Escalate patient concerns as necessary.
- Inbound and outbound member, provider, and physician calls. Answer questions related to pharmacy benefits while maintaining productivity standards and performance guarantees, where applicable.
- Work with various operational departments to research and resolve mail order and claims issues, and respond to members within performance agreement guidelines.
- Maintain accurate and complete documentation of all inquiries to continuously improve the customer service process, and reduce potential legal concerns.
- Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited.
Re-auth Coordinator
CURASCRIPT SPECIALTY PHARMACY
Orlando, Florida
05.2006 - 01.2014
- I was responsible for checking the accounts in a list, and initiating the reauthorization process with insurance companies.
- Handle the escalation emails from the representatives regarding authorizations, overrides, and claim rejections.
- Assist new employees by coaching them about our computer systems and procedures.
- Back up for the user hold team, fixing and expediting orders, and the eligibility check team, making sure the benefits are still up to date.
- When assistance is needed, I work in different positions to help avoid delays and work disruptions.
Education
Being a good Mentor, Build a Personal Learning Plan and Stick with it, Business Etiquette for the Modern Workplace, Change Management Foundation, Change Management Tips for Individuals, Communicating with Diplomacy and Tact, Critical Thinking, Crucial Conversations get Abstract Summary, Customer Service Call Strategies, Customer Service Call Control Strategies, Customer Service Handling Abusive Customers, Customer Service Problem Solving and Troubleshooting, Deescalating Conversations for Customer Service, Developing You Emotional Intelligence, Discovering your Strengths, Empathy at Work, Grammar Foundation
Linked In Classes
01-2024
Marketing - Incomplete
Estácio de Sá University
Skills
- Benefit verification
- Prior authorization
- Patient advocacy
- Case management
- Financial assistance
- Program coordination
- Regulatory compliance
- Data review
- Problem solving
- Effective communication
- Relationship management
- Documentation management
- Patient education
- Team collaboration
- Medical records management
- Multitasking and organization
- Resource identification
- Clear communication
- Documentation proficiency
- Stakeholder collaboration
- Positive attitude
- Verbal and written communication
- Problem-solving
- Case needs assessment
- Data entry and analysis
- Case management tracking
- Email and telephone etiquette
- MS office
- Time management
- Performance tracking
- Insurance regulations
- Financial support
References
References available upon request.
Languages
- Portuguese
- English
Timeline
Reimbursement Case Manager - Verona Patheway Plus
Caremetx
10.2023 - Current
Reimbursement Specialist
Eversense Benefits Support Program
04.2023 - 10.2023
Reimbursement Specialist
Appelis Assist Program
10.2022 - 04.2023
Prior Authorization and Appeal Specialist
Kroger Specialty Pharmacy
07.2016 - 10.2022
Patient Care Coordinator – PA and BI Coordinator
PRIME THERAPEUTICS SPECIALTY PHARMACY
01.2014 - 07.2016
Patient Care Coordinator (User Holds)
CURASCRIPT SPECIALTY PHARMACY
05.2006 - 01.2014
Patient Care Coordinator (Patient Care Contact Center)
CURASCRIPT SPECIALTY PHARMACY
05.2006 - 01.2014
Re-auth Coordinator
CURASCRIPT SPECIALTY PHARMACY
05.2006 - 01.2014
Being a good Mentor, Build a Personal Learning Plan and Stick with it, Business Etiquette for the Modern Workplace, Change Management Foundation, Change Management Tips for Individuals, Communicating with Diplomacy and Tact, Critical Thinking, Crucial Conversations get Abstract Summary, Customer Service Call Strategies, Customer Service Call Control Strategies, Customer Service Handling Abusive Customers, Customer Service Problem Solving and Troubleshooting, Deescalating Conversations for Customer Service, Developing You Emotional Intelligence, Discovering your Strengths, Empathy at Work, Grammar Foundation
Linked In Classes
Marketing - Incomplete
Estácio de Sá University