Candace Baker
Clermont,FL
Summary
Quality=driven Field Reimbursement Manager thinking outside-of-the-box. Offering more than 10 years of observing data confidentiality requirements, keeping accurate records and assessing data. Experienced in working closely with team members, upper management and other key stakeholders.
Overview
12
12
years of professional experience
Work History
Field Reimbursement Manager
Mckesson
02.2022 - Current
- Demonstrates deep knowledge of reimbursement and access, and function compliantly as subject matter expert in their assigned territory
- Demonstrates extensive knowledge of individual managed care account’s geographic presence/influence, payor mix, product coverage and reimbursement criteria policies
- Educates providers and LTC facilities on prior authorization requirements, coverage status, payer appeals requirements, alternate funding options for uninsured and under insured, and all associated processes and timelines
- Maintains required SLAs per client contract
- Routinely provide access education to HCPs, LTC facilities and office staff
- Creates and maintains productive relationships with HCPs, LTC facilities, other key stakeholders within HCP offices, and health care systems
- Collaborates with cross-functional partners to identify and respond to local opportunities and customer needs
- Travels within multi state territory to work w HCP, LTC facilities and all other stakeholders as needed.
ENROLLMENT/BILLING ANALYST
Cigna
12.2019 - 01.2022
- Managed 50 plus pharmacy contracts monthly regarding billing, invoicing and collections
- Researched, analyzed, corrected complex billing and payment issues
- Collaborated with Account Directors in order to perform monthly, quarterly, semi-annual and annual reviews
- Coordinated with various internal departments to ensure compliance of agreements, determine reports required for billing and accuracy of fees billed
- Performed and assisted on multiple implementations with new pharmacy clients
- Communicated clearly and effectively to pharmacy internal partners related to billing/collection status for agreements
- Escalated unresolved complex issues as needed
- Communicated with external pharmacy Clients to review related billing/collection status.
Resident Supply Specialist
Mckesson Patient Care Solutions
10.2016 - 05.2019
- Managed 90 Long Term Care Facilities as it pertains to wound care, ostomy, catheter and tracheostomy supplies for Medicare B residents monthly
- Provided in-services and education to LTC staff about Medicare allowable and requirements for different categories
- Ensured that all proper documentation is received in order to bill for resident’s supplies
- Performed and assisted with Implementations as new business comes on board
- Attended quarterly reviews and work with sales team and corporate account managers as it pertains to accounts
- Obtained 90% or higher active orders from facilities monthly
- Sold services to additional buildings not currently using all services available
- Met with key contacts on monthly basis: administrators, doctors and directors of nursing via face to face, or over video/telephone.
Field Support Specialist/account manager
Mckesson Medimart
08.2014 - 09.2016
- Completed initial patient and order set up process for new accounts
- Complete initial patient and order set up process for new accounts
- Completed monthly re-order process for established accounts
- Reviewed monthly product re-order guide prepared by Medimart for designated facilities
- Assessed product inventory at facility and report any overage or shortage by fax or phone to Medimart service center personnel including any returns
- Completed any required call reports to indicate results of visit
- Obtained 90% or higher active orders from facilities monthly
- Initiated appointments with key contact at facility to review re-order guides
- Reduced overall adjustment rates by 0.5% each month by focusing on top adjustments
- Met with key contacts on monthly basis: administrators, doctors and directors of nursing via face to face, or over video/telephone.
- Responded to customer inquiries and provided technical assistance over phone and in person
Medical Billing Manager
Success EHS
04.2012 - 01.2014
- Experienced billing for Family Medicine, Podiatry, and OBGYN specialties
- Ensured claims are entered and submitted within 48 hours of receipt
- Accurately applied payments to patient accounts
- Posted and reconciled insurance and patient payments
- Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts
- Ensured accuracy of insurance claims
- Worked with clearinghouse to resolve file compatibility issues
- Retrieved Electronic Remittance Advice (ERA's)
- Sent secondary claims upon processing of primary insurance and monthly processing of patient statements
- Answered and resolved patient billing questions
- Followed up on insurance and patient aging
- Re-submitted insurance claims as necessary
- Knowledgeable in timely filing restrictions
- Hosted annual, quarterly and month business reviews with clients
- Managed team of 6 other billers
- Conducted performance counseling and disciplinary actions as needed
- Assisted with staff development, including on-going mentoring and training.
Education
Master of Science - Management And Leadership
Liberty University
Lynchburg, VA05.2012
Bachelor of Science - Business
Tennessee Temple University
Chattanooga05.2010
Skills
- Time Management
- Medical Reimbursement
- Written and Verbal Communication
- Policy Analysis
- Issue Resolution
- Complaint Resolution
- Account Management
- Key Holder Experience
- Staff Education and Training
- Proofreading
Timeline
Field Reimbursement Manager
Mckesson
02.2022 - Current
ENROLLMENT/BILLING ANALYST
Cigna
12.2019 - 01.2022
Resident Supply Specialist
Mckesson Patient Care Solutions
10.2016 - 05.2019
Field Support Specialist/account manager
Mckesson Medimart
08.2014 - 09.2016
Medical Billing Manager
Success EHS
04.2012 - 01.2014
Master of Science - Management And Leadership
Liberty University
Bachelor of Science - Business
Tennessee Temple University
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