Burnice Saye
East Orange,NJ
Summary
Hardworking individual with excellent communication skills, knowledge of drugs, medicines and therapeutic agents as well as an excellent problem-solving ability with an exceptional customer service skills seeking positions within the Healthcare & Pharmaceuticals industry to collaborate interactively with patients, healthcare providers, pharmacies, and manufacturer clients.
Overview
12
12
years of professional experience
Work History
Senior Insurance/ Reimbursement Analyst II
Abbvie
Chicago, IL
10.2023 - 10.2025
- Assisted with preparing and analyzing financial forecasts/budgets.
- Maintained existing and developed new analytic tools related to Medicare and Medicaid reimbursement policy.
- Verified accuracy of Modeling Contract or Medicare/Medicaid reimbursement.
- Reviewed and analyzed State and Federal hospital reimbursement policy.
- Assisted in coordinating communications, education sessions, and workgroup meetings based on analysis of State and Federal rules and regulatory changes.
- Gathered pertinent information from insurance carriers, financial counselors, and other ancillary staff to make certain the patient's financial obligations for services provided.
- Assisted with preparing and analyzing financial forecasts/budgets.
- Acted as the primary point of contact for Health Care Providers (HCPs) and patients when addressing complicated patient access challenges.
- Monitored and evaluated existing policies to ensure coverage adequacy and make recommendations for adjustments.
- Identified potential Adverse Event situations for reporting to Pharmacovigilance ensuring the company met FDA regulations.
- Supported management of the clinical trial insurance process and its respective audit.
- Arranged for timely payment of costs associated with risk management and maintain accurate records of risk expenditures, including loss costs.
- Prepared and updated clinical trial investigator medical malpractice grid.
- Assisted in the evaluation of risk financing alternatives and adequacy of limits.
- Stay up to date on complex insurance regulations.
Senior Reimbursement Analyst
Caremetx
04.2021 - 01.2023
- Maintained existing and develop new analytic tools related to Medicare and Medicaid reimbursement policy.
- Verified accuracy of Modeling Contract or Medicare/Medicaid reimbursement.
- Reviewed and settled Medicare cost reports and reports results to management.
- Assisted in coordinating communications, education sessions, and workgroup meetings based on analysis of State and Federal rules and regulatory changes.
- Assist with preparing and analyzing financial forecasts/budgets.
- Reviewed and analyzed State and Federal hospital reimbursement policy.
- Always ensured a positive work environment and as well as a team player.
- Identified areas for financial improvement related to payer contract behavior.
- Gathered pertinent information from insurance carriers, financial counselors, and other ancillary staff to make certain the patient's financial obligations for services provided.
- Assisted with preparing and analyzing financial forecasts/budgets.
- Analyzed financial variances.
- Ensured all CMS and all company guidelines were always followed.
- Entered referrals and documented communications, actions, and other data in an information system.
Senior Reimbursement Analyst
ConnectiveRX
02.2018 - 01.2021
- Analyzing and providing tools for reimbursement and other patient assistance program.
- Service as point of contact for vendors as well as ensure vendor agreements are up to date and coordinates renewal reimbursement and access solution to benefits.
- Monitoring FAQs to provide effective training tools regarding managing annual assessment and updates of reimbursement and patient assistance programs.
- Conducts and generate monthly report on utilization and effective budgeting.
- Ensure compliance with The Joint Commission and all other Federal, State and Regulatory Agencies.
- Facilitates the development of new tools and execution internal and external training on reimbursement tools, resources, webinars.
- Independently analyzed, reports, and communicates any reimbursement trends/delays, fraud (e.g., billing denials, claim denials, pricing errors, payments, etc.).
- Supported payer relations with coverage monitoring and new development speaking positively about others, listening attentively, and observing the Patient Bill of Rights and Confidentiality.
Reimbursement Analyst
AmerisourceBergen
10.2015 - 12.2017
- Accurately interpreted patient insurance, prescription, and other health-related documentation.
- Communicated with insurance companies, patients, providers, and prescribers to coordinate reimbursement and access solution.
- Participated in Quality Assessment (QA) and Quality Improvement (QI) programs, as directed.
- Ensure compliance with The Joint Commission and all other Federal, State and Regulatory Agencies.
- Completed casework in a timely manner with consistent follow-up as the accountable case manager.
- Maintained patient confidentiality.
Sr Application Data Specialist
Willis Towers Watson
07.2013 - 09.2015
- Collected and reviewed all patient insurance information needed to complete the billing, collections, appeal, and/or cash processes.
- Participated in Quality Assessment (QA) and Quality Improvement (QI) programs.
- Completed and submitted all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third-party payers. Researches and resolves any electronic claim denials.
- Maintained frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
- Maintained confidentiality regarding patient account status and the financial affairs of clinic/corporation.
- Independently analyzed, reports, and communicates any reimbursement trends/delays (e.g., billing denials, claim denials, pricing errors, payments, etc.).
- Maintained positive working relationships as a collaborator through problem solving issues, speaking positively about others, listening attentively, and observing the Patient Bill of Rights and Confidentiality.
Education
BSN - Nursing
Trinitas School of Nursing
03.2026
BA - Public Administration
Kean University
01.2013
Skills
- Strong written and verbal communication skills
- Ability to work in a fast-paced environment
- Punctual
- Organized and strong attention to details
- Friendly and great Customer Service skills
- Knowledgeable with Medical Terminology
- Dependable and Flexible
- Top Performer
- Knowledgeable on Medicare and Medicaid policies and terms
- Microsoft Office
- Adjustment and Cost Report
Timeline
Senior Insurance/ Reimbursement Analyst II
Abbvie
10.2023 - 10.2025
Senior Reimbursement Analyst
Caremetx
04.2021 - 01.2023
Senior Reimbursement Analyst
ConnectiveRX
02.2018 - 01.2021
Reimbursement Analyst
AmerisourceBergen
10.2015 - 12.2017
Sr Application Data Specialist
Willis Towers Watson
07.2013 - 09.2015
BSN - Nursing
Trinitas School of Nursing
BA - Public Administration
Kean University