Arminthia Thomas-Davis

• Assisted clients with accurate eligibility form, application and document completion.
• Actively participated in professional development opportunities, staying current on industry trends and updates that may impact eligibility determinations.
• Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
• Conducted ongoing training sessions for employees, ensuring up-to-date knowledge on policy changes and best practices in the field of eligibility determination.

• Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
• Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
• Conducted regular audits to ensure compliance with regulatory standards and insurance company policies related to the approval process.
• Processed patients lacking coverage for planned procedures.

· Responsible for overseeing 20 agents

· Provided guidance and feedback to the agents as to their work performance

· Provide support to the employees as they perform their daily task

· Maintained record keeping of employee metrics

· Ensured employees adhered to the attendance policy

· Maintained open communication with Senior Leadership concerning any behavior or coaching opportunities

· Involved and attended leadership meetings

· Facilitator of several Up Training classes

• Ensured compliance with local, state, and federal regulations during all phases of the eligibility determination process.
• Reviewed applications for different aid programs and determined which qualification criteria for individuals.
• Devised and implemented strategies to streamline eligibility verification processes.
• Conducted extensive research on available resources to connect clients with appropriate community services and support networks.
• Responsible for verification of Benefits and Eligibility for all referrals assigned to me from medical doctor offices and pharmaceutical manufacturer within the first 24 hours of receipt. Investigation of benefits and eligibility by phone and/or internet to determine coverage choices patient has in starting therapy.
• Documentation of insurance information and patient status in the appropriate areas of database to assist callers with patient accounts.
• Communicating with referral source and patient to provide continual status of patient referral.
• POC for some physician offices-responsible for communicating information to physician effectively and in a professional manner.
• Responsible for triaging referrals to the appropriate Specialty Pharmacy contracted with the patient’s insurance plan.

• Optimized claim processing times by implementing efficient workflows and leveraging automation technologies.
• Responsible for verifying insurance benefits, obtaining prior authorizations and reauthorizations and validating accurate billing information to ensure claims are paid for drug shipment.
• Documentation of insurance information and patient status.
• Communicate with patients, and physician offices concerning status and benefit information.

• Work with multiple entities to coordinate care and/or resolve issues for Cinryze patients.
• Tracks & proactively works re-authorizations, LOA, or any other patient concerns.
• Works and resolves all daily claim rejections.
• In-depth benefit investigation on initial referrals on medical and prescription plans.
• IV team has to remain in compliant with the established guidelines for follow up with the Physician Office, Patients, and Clients

• Optimized core processes to improve business performance and operational agility.
• Promoted to lead team of 15 employees in daily call center operations.
• Provide internal & external support to B&R escalated phone queue.
• Review aging report & call on unpaid claims.
• Conduct monthly phone audit of fellow employees.
• Review, research & dispute chargeback documents with merchants.
• Communicated insurance plans on unpaid or short paid claims.