April Campos
Covina
Summary
Dynamic Field Reimbursement Manager with over 24 years of diverse healthcare experience, dedicated to delivering innovative solutions that enhance access, affordability, and quality of care for patients and providers. Expertise in navigating complex reimbursement landscapes and providing comprehensive support to provider offices in resolving intricate coverage challenges. Proven track record in overseeing successful biologic injectable product launches, particularly within Women's Health, Immunology, Rheumatology, Oncology, and Gastroenterology specialties. Recognized for strong team collaboration and a results-driven approach, with a solid foundation in financial analysis and regulatory compliance to drive organizational success.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Access and Reimbursement Manager
CoverMyMeds
09.2023 - Current
- Results-driven Field Reimbursement Manager with extensive experience in patient access, reimbursement strategy, and provider support within the pharmaceutical industry. Proven track record of facilitating timely access to therapies by navigating complex payer landscapes, resolving reimbursement challenges, and educating healthcare providers on coverage requirements.
- Skilled in mentoring and training new hires, fostering team development, and enhancing operational efficiency. Adept at building strong relationships with stakeholders across healthcare systems, specialty pharmacies, and internal teams to drive patient-centric outcomes and ensure compliance.
Field Reimbursement Manager
Xcenda
12.2019 - 08.2023
- Seasoned consultant and Field Reimbursement Manager at Xcenda, adept at providing comprehensive assistance to provider offices in resolving intricate coverage and reimbursement challenges for patients.
- Proven expertise in overseeing successful biologic injectable product launches, with a strong focus on Women's Health, Immunology, Rheumatology, Oncology, and Gastroenterology specialties.
- Diligently managing the review process for grievances, appeals, and denials, ensuring thorough investigation and leveraging compliance expertise to achieve favorable outcomes.
Field Reimbursement Manager
AmerisourceBergen
12.2019 - 08.2023
Financial Coordinator
CHOC Children's
06.2019 - 12.2019
- Served as the Financial Coordinator for Pediatric Endocrinology, ensuring that all appeals were processed in compliance.
- Maintained email resources, internal logs, and collaborated closely with supervisors and managers to facilitate smooth operations.
- Engaged with insurance providers to gather information on eligibility, benefits, network status, and authorization.
- Conducted thorough analysis of requests and accompanying documentation to determine coverage and approval, involving nurses for medical reviews as needed.
- Managed a high volume of requests for prior authorizations, referrals, appeals; aided with Grievances within a specialty clinic-hospital-based setting.
- Acted as a liaison between payers, clinic schedulers/medical support staff, medication manufacturers, and specialty pharmacies.
- Accurately coded each diagnosis of service and procedures using ICD-10 and CPT codes to maintain precise documentation and billing standards.
Domestic Violence Advocate
YWCA San Gabriel Valley
02.2016 - 10.2019
- Conducted intervention assessments of families and provided counseling services to individuals and groups affected by domestic abuse, offering support and guidance.
- Responded to hotline calls, providing a compassionate and empathetic ear to victims of violence, and collaborated with other agencies to secure shelter and necessary resources for abuse victims.
- Empowered and motivated victims to transition from a state of victimhood to survivorship, fostering self-confidence and assisting in the healing process.
Medical Office Manager
Tenet Healthcare
09.2014 - 05.2019
- Effectively managed the authorization and referral process for Growth Hormone procedures, hormone therapy, and outpatient surgery, ensuring timely and accurate coordination of patient care.
- Served as a patient advocate, advocating for patients in appeals and denials with various insurance companies.
- Performed both front and back office duties, including efficiently scheduling and answering patients' appointments.
- Verified insurance coverage and submitted prior authorizations, facilitating seamless reimbursement and minimizing delays.
Medical Assistant
Caduceus Medical Group
02.2013 - 08.2014
- Conducted efficient patient check-in procedures by verifying insurance coverage, updating demographic information, and collecting co-payments, ensuring accurate and up-to-date records.
- Managed the scheduling and rescheduling of patients' appointments, including coordinating surgery schedules with contracted hospitals, ensuring optimal patient care coordination.
- Provided training and education to new hires on medical office procedures, contributing to the smooth on-boarding process.
- Supported podiatrists, general surgeons, dermatologists, and plastic surgeons during minor procedures, demonstrating a strong understanding of sterile techniques and procedural support.
Medical Authorization Tech
Los Angeles County Department of Health Services
04.2012 - 08.2012
- Collected and accurately coded health information, ensuring proper reimbursement, statistical analysis, and mandatory reporting for the County hospital or complex care facility.
- Engaged in regular communication with hospitals or complex care facilities to obtain updates on patient status, facilitating the timely processing of claims and ensuring accurate information.
- Reported collected information to Registered Nurses for final approval of claims, maintaining compliance with healthcare regulations and billing requirements.
- Utilized designated computer-based coding systems to select appropriate diagnoses and procedures codes, ensuring accuracy and consistency in coding practices.
- Collaborated with service providers to update the encounter form, facilitating accurate billing and reporting of services rendered.
- Completed UB92 and other insurance claim forms as necessary, adhering to insurance guidelines and requirements.
- Demonstrated proficiency in utilizing coding systems such as ICD-9-CM, CPT/HCPCS nomenclature, and Ambulatory Payment Classifications (APCs), ensuring accurate and standardized coding practices for optimal reimbursement and reporting.
Medical Assistant Float
Bright Health
06.2007 - 07.2011
- Demonstrated flexibility and adaptability by providing support across multiple specialty offices, including Urgent Care, Cardiology, Pediatrics, Orthopedics, and Internal Medicine, ensuring seamless patient care and efficient operations.
- Managed multiple phone lines, efficiently handling inquiries, verifying patient eligibility, scheduling and canceling appointments, and collecting co-payments, ensuring a smooth patient experience.
- Accurately inputted ICD-9 codes and CPT codes for billing purposes, ensuring proper documentation and reimbursement.
- Handled workers' compensation claims and facilitated the processing of referrals and authorizations for specialty offices, ensuring timely access to specialized care for patients.
- Performed a wide range of clinical procedures including vital signs, weight and height measurements, minor surgeries, pap smears, suture removals, wound care, phlebotomy, injections, EKG, and colonoscopies, delivering high-quality patient care and support.
- Recorded patients' medical history, vital statistics, and lab results accurately into the electronic medical records (EMR) system, ensuring comprehensive and up-to-date patient records for healthcare providers.
Education
Medical Assistant - Medical Field
Concorde Career Colleges
01.2002
Associate's degree - Health/Health Care Administration/Management
Mt. San Antonio College
Health/Health Care Administration/Management
Mt. San Antonio College
01.2001
Skills
- HCPCS coding expertise
- Collaborative team management
- Medical coding expertise
- Denial resolution
- HIPAA compliance
- HCPCS coding
- Written and verbal communication
- Reimbursement management
Websites
Accomplishments
- Collaborated with team of 30 plus in the development of pharmaceutical market access.
Certification
- Delivering an Authentic Elevator Pitch
- Creating and Giving Business Presentations
- McKesson's Digital Literacy 101
- Medical Assistant
- Developing a Learning Mindset
Timeline
Access and Reimbursement Manager
CoverMyMeds
09.2023 - Current
Field Reimbursement Manager
Xcenda
12.2019 - 08.2023
Field Reimbursement Manager
AmerisourceBergen
12.2019 - 08.2023
Financial Coordinator
CHOC Children's
06.2019 - 12.2019
Domestic Violence Advocate
YWCA San Gabriel Valley
02.2016 - 10.2019
Medical Office Manager
Tenet Healthcare
09.2014 - 05.2019
Medical Assistant
Caduceus Medical Group
02.2013 - 08.2014
Medical Authorization Tech
Los Angeles County Department of Health Services
04.2012 - 08.2012
Medical Assistant Float
Bright Health
06.2007 - 07.2011
Associate's degree - Health/Health Care Administration/Management
Mt. San Antonio College
Health/Health Care Administration/Management
Mt. San Antonio College
Medical Assistant - Medical Field
Concorde Career Colleges
Publications
Trailblazers
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