Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
References
Timeline
Generic

Conita Ross

Charlotte,NC

Summary

Dedicated, highly adept healthcare consulting professional with 10+ years of medical reimbursement and workflow process management within the pharmaceutical industry. Skilled in fostering essential relationships with partners, providers, and healthcare facilities to garner client retention and promote comprehension of payer guidelines. Quickly adaptable to new systems, protocols, and able to resolve complex problems. Highly experience with Risk Evaluation and Mitigation Strategy (REMS), infusion, injectable, oral, and buy & bill market in both the hospital and clinic settings. Can identify and solve potential problems and conflicts with account claims, payer related challenges & medical policy. Experienced in oncology, neurology, endocrinology, & rheumatology.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Operations Manager-Remote

CareMetx
Bethesda, MD
07.2023 - 12.2023
  • Improved productivity initiatives, managing budgets and accounts, coordinating itinerary and scheduling appointments.
  • Identified areas of deficiency and performed root-cause analysis to solve problems.
  • Established and maintained positive working relationships with community organizations, acting as corporate representative at meetings and events.
  • Completed thorough opening, closing and shift change functions to maintain operational standards each day.
  • Supervised day-to-day workflow of employees in order to maximize productivity and maintain quality standards.
  • Recruited, hired and trained crew members on application of projects, customer relations, and customer service.
  • Integrated technology to increase efficiency and real-time accountability of operational tasks.
  • Used strong issue resolution and communication skills to cultivate and strengthen lasting client relationships.
  • Created corrective actions based on adverse KPI trends.
  • Structured HR consulting services to support clients during organizational developments and changes.
  • Prepared staff work schedules and assigned team members to specific duties.
  • Guided employees on understanding and meeting changing customer needs and expectations.
  • Collaborated with management team on long-term strategic planning initiatives for the organization.
  • Managed staffing needs through recruitment, selection, onboarding and training, disciplinary action as necessary.
  • Produced SOPs to document workplace procedures and optimize productivity through standardization.
  • Connected with clients and developed strategies to achieve sales and customer service goals.
  • Analyzed, compiled and presented statistical, financial, and production processing reports to senior leadership.
  • Developed initiatives for process improvement and reviewed and assessed ongoing operations.
  • Developed and implemented operational procedures to ensure quality standards are met.

Patient Access Consultant -Remote

Amerisource Bergen -Lash Group
Fort Mill, SC
11.2014 - 07.2023
  • Act as liaison working as the HUB, collaborating between sales, provider offices, healthcare facilities and patients.
  • Built and maintained strong relationships with partners, providers,a nd healthcare facilities to ensure client retention and understanding payer guidelines.
  • In addition to working in partnership with external partners and stakeholders regarding pull and push-throughs, dosing requirements, and administration of pharmaceutical products.
  • Act as single point of contact responsible for prior authorization and appeal processing communication to patients, healthcare providers, Sales Force, and other external stakeholders.
  • Educates providers’ offices & infusion centers and their staff on various support services available and explains the importance of their role facilitating access of our therapy products.
  • Strong command of access and reimbursement fundamentals including in revenue cycle, buy and bill, formulary, prior authorization, coding, and appeals processes for specialty medical and pharmacy benefit products.
  • Troubleshoot complex cases, spanning multiple disease-states, while interfacing with key stakeholders to include internal and external to ensure optimal start to & continued therapy.
  • Safeguards accuracy of electronic claims & insurance records received prior to submitting them to third-party payers.
  • Subject matter expert relating to product procurement, buy and bill processes, billing and coding, access and medical policy.
  • Managed multiple regions over 150 providers' offices and acute care centers and achieved client satisfaction score of 95% or higher for 5 consecutive years.
  • Built long-lasting relationships with providers, practices, and hospitals by effectively explaining REMS mandates
  • Streamlined prior authorization process reducing average handling time by 30%.

Interim Program Manager -Remote

Amerisource Bergen -Lash Group
Fort Mill, SC
10.2021 - 02.2022
  • Greatly responsible for maintaining the integrity, accuracy, and applicability of KPI’s and associated KPI service level agreements (SLAs) during high volume of payer plan re-enrollment period.
  • Additionally, responsible for recommending KPI and SLA changes as well as facilitation regular quality reviews with executive leadership.
  • Collaborate with program sponsors, stakeholders, and end-users, throughout the organization to maximize utility and utilization during the Payor Reverification period, enabling users to track changes in performance following process improve initiatives.
  • Drive program performance by establishing performance metrics and goals; provide ongoing coaching and feedback to reinforce and address performance.
  • Analyze quality and performance reports for trends, make process improvements provide coaching or retrain where needed.
  • Manage the resolution of client issues and ensure appropriate follow up is done to manage client relationship: deliver routine client reports.
  • Collaborate with Compliance team on program audits, address and its finding and implement corrective actions.
  • Assisted in developing training materials such as user manuals or job aids as needed.
  • Generated and delivered reports, program review presentations and other program status updates.
  • Analyzed program data to assist in strategic decision-making.
  • Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.
  • Planned and delivered training sessions to improve employee effectiveness and address areas of weakness.
  • Collaborated with senior leadership to create strategic plans that aligned with business objectives.

Web Support Analyst

Amerisource Bergen -Lash Group
Charlotte, NC
11.2013 - 10.2014
  • Delivered essential support of website users and field team, answering inbound support calls, troubleshooting errors, and proactively solving user issues.
  • Trained users on web-based provider program use and functionality, consistently identifying business gaps and providing inclusive solutions.
  • Synchronized web portal access credentials across multiple platforms via SharePoint to improve efficiency.
  • Sustained record of accomplishment for 24-hour turnaround time for resolving issues as well as executing technology and provider portal assistance for contractual client.
  • Identified and resolved website glitches, server problems and incorrect formatting.
  • Implemented best practices for security protocols across all web servers.
  • Provided technical support for web-based applications, including troubleshooting and problem resolution.
  • Collaborated with developmental team to resolve usability issues and improve website functionality.
  • Ensured compliance with applicable regulations regarding data privacy and security.

Reimbursement Counselor

Amerisource Bergen -Lash Group
Charlotte, NC
11.2011 - 11.2013
  • Ensured accuracy of insurance forms and electronic claims submitted providing patient and provider information to third-party companies.
  • Directly oversaw claim process through payer prior authorization to appeal and denial procedures.
  • Gathered patient demographics, National Provider Identification (NPI) numbers, and referral information.
  • Protected the security of medical records to ensure confidentiality was preserved in compliance with HIPPA policies.
  • Determined medical necessity, using individual insurance carrier regulations.
  • Participated in meetings with internal stakeholders as well as external partners such as insurance providers to discuss issues related to billing and reimbursement procedures.
  • Reviewed uninsured accounts, verifying medical assistance application process, charity care application and drug replacement program availability.
  • Qualified claims for reimbursement by researching medical history, insurance coverage and coding.
  • Offered subject matter expertise on employment regulations, compensation policies and personnel management procedures to optimize internal structures.

Education

Bachelor of Science - Business Administration

Strayer University
Washington, DC
12-2008

Skills

  • Reimbursement Education and Management
  • Medical Billing and CPT Coding
  • Process Management
  • Medical Policy, HCPCs, and ICD 10 Codes
  • Medicare Part B & D & Misc J Codes
  • IV Infusible/Oral Medications
  • Buy & Bill/Specialty Pharmacy
  • Staff Training and Development

Certification

  • Certified Professional Coder -American Academy of Professional Coders Renews December 2024

Accomplishments

  • Bright Spot Awards recognition from contractual clients of service above and beyond.

May 2022, October 2020, May 2019, June 2018, April & August 2017

References

References available upon request.

Timeline

Operations Manager-Remote

CareMetx
07.2023 - 12.2023

Interim Program Manager -Remote

Amerisource Bergen -Lash Group
10.2021 - 02.2022

Patient Access Consultant -Remote

Amerisource Bergen -Lash Group
11.2014 - 07.2023

Web Support Analyst

Amerisource Bergen -Lash Group
11.2013 - 10.2014

Reimbursement Counselor

Amerisource Bergen -Lash Group
11.2011 - 11.2013

Bachelor of Science - Business Administration

Strayer University

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Conita Ross