Audrey Ross

Assisted both physician groups and patients beginning advanced pharmaceutical therapies related to pulmonary arterial hypertension.

• Gathered and deciphered insurance eligibility and benefits.
• Completed prior authorization submission for advanced therapies, durable medical equipment and administration.
• Negotiation with out of network insurance payers for one-time agreement for patient treatment.
• Quality assurance auditing of patient charts.
• Ongoing communication and problem-solving with prescribing physician and office staff
• Interpreter of benefits and start of care contact for patients starting specialty pharmaceutical therapy.
• Completed annual training in Windows and Excel software updates.
• Completed annual training in HIPAA and Medicare/Medicaid regulations.
• Proved successful working within tight deadlines and fast-paced environment.
• Proved successful working within tight deadlines and fast-paced environment.

Completed Long Term Care case review, care plan management, and claim decisions based on insurance plan provisions.

• Gather accurate benefit and provider eligibility for claimants based upon policy provisions, proposed care plans and assessment of clinical data.
• Insurance claim decision communication in both verbal and written to customers and clients.
• Claim processing during initial claim review and reassessments.
• Assist claimants through case monitoring, care plan management, and reassessments.
• Claims appeal processes and interpretations.
• Developed policies and procedures for effective pharmacy management.