Catherine D. Sprague
Jenks,OK
Summary
Executive Patient Access Specialist with over 5 years of experience in Field Reimbursement and 9 years in Pharmaceutical Sales. Specializing in complex drug benefit access and reimbursement. Extensive knowledge of pharmacy and medical benefit, buy and bill and assignment of benefit (AOB) coverage. Deep understanding of local and national formulary and managed care systems. Excels at patient pull-thru. Fluent in medical billing and coding. Strengths include customer relationship building and large territory management. Life-long learner, self-motivated, and highly organized. Seeking position in Field Reimbursement in Tulsa, OK area. Willing to travel.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Executive Patient Access Specialist
Syneos Health (inVentiv) - Janssen Pharmaceuticals
12.2018 - Current
- Worked hand-in-hand with treatment centers to provide education on deciphering complex benefit coverage and obtaining necessary prior authorizations.
- Regularly aided offices in overcoming complicated access barriers, resulting in more patients starting & staying on therapy.
- Became acknowledged Subject Matter Expert in Patient Affordability Programs. Conducted training for teammates to increase their proficiency and optimize patient pull-thru in all territories.
- Proactively & regularly researched local and national managed care policies and advised offices on changing payer landscape and requirements.
- Worked with local stakeholders to enact benefit change for Oklahoma Medicaid, leading to huge increase in access for lower socio-economic patient population.
- Collaborated with Janssen home office colleagues to leverage field based knowledge & insight to improve patient programs, resources and assistance options.
- Partnered with Specialty Pharmacy Senior Contracting Managers to improve patient fulfillment experience. Developed training to share learnings with national PAS team.
- Participated in Verification of Benefits calibration/quality control task force to ensure accuracy and clarity of benefits investigations & clear direction for treatment centers.
- Independently learned how to navigate external prior authorization sites in order to improve customer experience. Self taught in Cover My Meds & Availity.
- Partnered with billing teams to identify coding errors and discrepancies, helping to ensure proper reimbursement.
- Forecasted routing schedule to include specific checkpoints in treatment center lifecycle, such as introduction to prior authorizations thru reviewing claims reimbursement.
- Demonstrated flexibility in covering a large territory as well as the states of Texas & Colorado as interim PAS. Acted quickly during peak hours or emergencies, prioritizing tasks & effectively meeting deadlines.
- Handled patient information and confidential medical records in compliance with HIPAA privacy rule standards and Janssen Rules of Engagement.
- Served as mentor and trainer to new colleagues.
- Both territories are currently in top 10 in sales rankings, due in part to high percentage of patient pull-thru.
Merck Pharmaceuticals
Senior Sales Representative
01.2010 - 06.2014
- Merck VP Award 2013 - Top 10% of Sales Force.
- Exceeded sales goals every year.
- Serviced large rural territory - 200+ health care accounts.
- Expanded Cherokee Nation Health Services account, going from $100K in sales to over $10 Million in sales for Merck diabetes products.
- Launched multiple new drugs to healthcare providers while maintaining sales objectives for established drugs.
- Promoted drugs for Diabetes, Cholesterol, and ED.
- Maintained extensive and current understanding of managed care marketplace to include multiple private formularies, as well as Tribal Health & Federal/VA.
- Developed and implemented plan for Diabetes Education for more than 1000 low income/rural Oklahomans.
- Submitted weekly activity & call reports, as well as in-depth territory analyses.
Merck Pharmaceuticals
Sales Representative
08.2005 - 01.2010
- Merck Director's Award 2007 - Top 15% of Sales Force.
- Met or exceeded sales objectives every year.
- Appointed as Account Lead for Cherokee Nation Health Services account, resulting in over $3 Million in annual sales for Merck cholesterol products, a growth of over 90% in revenue.
- Analyzed data to maximize ROI by comparing potential customer sales.
- Continually honed marketplace insight by remaining current on health care laws and statutes, formulary status, FDA rulings, and developments. Used this knowledge to compare Merck sales and adjusted course accordingly.
- Planned and documented use of yearly budget for marketing, customer education and resource costs.
- Promoted Merck drugs for Asthma, Cholesterol, & Migraine.
- Appointed Tulsa's Change Agent to oversee Merck's merger with Schering Plough.
UICI, United Healthcare
Division Manager
02.2003 - 08.2005
- Managed team of 15 developers and testers to resolve systems issues related to implementation and maintenance of new medical claims processing system and health insurance purchasing interfaces for 100+ individual United Health Care benefit plans.
- Developed deep knowledge of private insurance marketplace.
- Resolved application issues to allow customers to receive assigned medical benefits and correctly processed medical claims.
- Regularly interfaced with policy holders. Developed project and communication plans to track & report status of high profile/urgent fixes and enhancements and sought ways to exceed customer expectations.
Arthur Andersen
Consultant
09.1998 - 02.2003
- Lead team of Change Management Consultants hired to implement specific software applications and corresponding training across multiple client sites.
- Designed, developed, and delivered software training to Fortune 500 clients.
- Created project plans to manage logistics for nation-wide software training rollouts to over 1000 employees both remotely and in person.
- Created and executed communication plans to update both internal and external stakeholders.
Education
M.A. - Organizational Communication
Baylor University
Waco, TXB.A. - Telecommunications
Baylor University
Waco, TXSkills
- Prior authorization & appeals
- Medical billing & coding
- Claim reimbursement
- HCP & office education
- Expert on local & national payer landscape
- Large territory management
- Building customer rapport
- Partnering with internal & external stakeholders for improved patient experience
- Patient pull-thru
- HUB coordination
- Partnering with Specialty Pharmacies
- Patient affordability programs & processes
- Anticipates & prepares for marketplace changes
- Strategic account planning
- Strong interpersonal & written communication skills
Certification
- Project Management Professional certification - CAPM
Timeline
Executive Patient Access Specialist
Syneos Health (inVentiv) - Janssen Pharmaceuticals
12.2018 - Current
Merck Pharmaceuticals
Senior Sales Representative
01.2010 - 06.2014
Merck Pharmaceuticals
Sales Representative
08.2005 - 01.2010
UICI, United Healthcare
Division Manager
02.2003 - 08.2005
Arthur Andersen
Consultant
09.1998 - 02.2003
M.A. - Organizational Communication
Baylor University
B.A. - Telecommunications
Baylor University
- Project Management Professional certification - CAPM
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