Monica Lane

Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer
calls to drive first call resolution.

Provide insurance coverage, verification details prior authorization statues
and alternate funding options for existing and newly launched products.

Provide offices with current plan
forms, portals, and websites for prior authorizations and appeal submissions. Clearly communicate and
educate customers on results of the investigation
Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex
access, savings card/copay card challenges or non-preferred formulary issues. Where necessary, complete a
benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor.
Quickly learn and execute business process and system changes for all drugs and channel sources as
applicable. Maintain an understanding of current business procedures, deviations, and case processing for all
brands and channel sources for Insurance Specialist I role to support as needed.
Documents information in the appropriate system of recordand formats. Accurately communicate insurance
details to HCP and patients via phone, other electronic communication methods and fax, as per established
policies and procedures.
Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA
regulations.
Support changing business priorities by being flexible in executing or overseeing completion of specific
tasks to support the patients, products, or services we provide for all current and new products.
Work cross-functionally to identify and share opportunities for process and productivity improvements.
Liaise between healthcare providers, insurance companies, AbbVie Patient Access Support field rep.s,
Ambassadors, filling pharmacies and patients to administer the Patient Support Service programs. Educate
healthcare providers, AbbVie Patient Access Support field representatives, filling pharmacies, and patients
on access processes specific to their patient's insurance plan.
Meet or exceed department standards relative to performance metrics. Maintain a work environment that
upholds privacy standards required by law and AbbVie policy.
Act as a resource for the Training department including providing support for training curriculum and new
hires.

Provide side by side coaching and assistance for Insurance Specialist Level 1s. Successfully complete
role based training requirements, including passing certifications and competency assessments prior to
conclusion of training period.
Understand and comply with all required training, including adherence to federal, state, and local laws, SPII
policies and guidelines, and the policies and procedures of AbbVie Access Support and AbbVie. Perform
additional tasks, activities, and projects as deemed necessary by management.

• Ensures accounts are financially secure by reviewing and documenting benefits, patient liabilities, authorization/pre-certification requirements, notification requirements, and other relevant information
• Assists with resolving electronic health record (EHR) work queues that support insurance verification
• Generates reports and assists with department correspondence as directed
• Initiates authorization for services as needed utilizing clinical information provided by the ordering physician
• Monitors and tracks authorizations, including ensuring accurate Current Procedural Terminology (CPT) codes, location of service performed and expiration dates
• Communicates to resolve complex patient access and quality service matters
• Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution
• Communicates openly in a non-judgmental and professional demeanor.

• Reached out to insurance carriers to obtain prior authorization for testing and procedures.
• Verified eligibility and compliance with authorization requirements for service providers.
• Input all patient data regarding claims and prior authorizations into system accurately.
• Fielded telephone inquiries on authorization details from plan members and medical staff.
• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.

• Conducts hourly rounding to ensure patient needs are met and records data established by policy and procedure, and reports observations and patient problems to the licensed nurse (ADL's) within unit specific defined limits and job scope, such as assistance with patient elimination, hygiene, comfort, safety, nutrition, and progress activity and practices Patient and Family Centered Care.

• Manage work queue to department standards for productivity and quality
• Verifies insurance benefits for new and current patients
• Re-verifies insurance benefits for existing patients
• Reviews all medical documentation against medical policy and initiates/obtains predetermination, pre-certification, and authorizations as needed
• Follow-up on pending pre-certifications and/or predeterminations until the outcome is decided
• Updates and maintains insurance and authorization information in PerpB software
• Obtains PCP referrals as needed
• Completes special projects as assigned
• Interacted with insurance providers to obtain necessary documents to complete authorization for Infusion Therapy.

• Responds to in-bound, routine customer telephone inquiries regarding products, services, order status, and other general questions
• Escalates inquiry to product support, billing, sales or return/repair based on complexity and nature of customer issue
• Logs calls and updates customer account records
• Takes initial customer calls and answers general questions regarding company products and services
• Other responsibilities include data entry, use of internal databases to answer customer questions and writing internal/external non-technical documentation
• Documents customer concerns and forwards complaint trends to appropriate departments
• Followed up with clients to verify optimal customer satisfaction following support engagement and problem resolution
• Configured hardware, devices and software to set up work stations for employees.

• Obtain all necessary information from patients to verify insurance coverage
• Answering incoming calls and making outbound phone calls to patients and payers
• Assured timely verification of insurance benefits prior to patient procedures or appointments
• Observed strict procedures to protect sensitive patient information, medical records and payment data
• Maintained strong knowledge of basic medical terminology to better understand services and procedures
• Verified client information by analyzing existing evidence on file
• Answered telephone calls to offer office information, answer questions and direct calls to staff
• Assisted members with password reset and set-up of account.

• Research and resolve a daily average of 35 - 45 routine and complex enrollment or billing issues due to lack of information or incorrect information
• Contact practices to complete enrollment and/or obtain the correct insurance information
• Contact patients to obtain information necessary to complete enrollment or verify insurance
• Contact various insurance companies either by phone or web site portals to obtain insurance benefit details
• Contact primary or secondary insurance companies to verify eligibility and/or coverage
• Create or complete new patient accounts Obtain authorizations on accounts as needed
• Electronically note accounts for various reasons, including; but not limited to, inability to verify; special instructions from the physician/practice; incomplete verification; and similar issues
• Utilize the Customer Relationship Management System, availity and related systems in order to locate missing patient information not listed on the enrollment form received
• Work accounts diligently based on the expected quota and quality standards in order to close the month timely
• Work closely with other departments as deemed necessary in order to accurately prepare the account for billing
• Employees may be required to actively participate in team meetings
• Other duties as assigned
• Set-up members transportation for patient appointments.

• Directed and controlled 401K, medical, dental and vision benefit packages
• Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in-person interactions
• Explained benefits to plan participants in easy to understand terms in order to educate each on available options
• Coordinated submission and assist in set-up of life insurance policies
• Answered constant flow of customer calls with minimal wait times
• Offering advice and assistance to customers, paying attention to special needs or wants
• Collected customer feedback and made process changes to exceed customer satisfaction goals.