Overview
Work History
Education
Summary
Timeline
Generic
Darleny Lee, MPH

Darleny Lee, MPH

Denver,CO

Overview

11
11
years of professional experience

Work History

Market Access Specialist

Terumo Blood and Cell Technologies, Inc.
10.2022 - 04.2025
  • Conducted health economics and outcomes research (HEOR) on company and competitor therapies for evidence generation.
  • Developed value dossiers in accordance with Academy of Managed Care Pharmacy (AMCP) guidance and payer expectations.
  • Quickly gained proficiency in the Definitive Healthcare claims database; leveraged it for analysis and taught peers how to use it.
  • Created budget impact models, sales support tools, and reimbursement guides.
  • Authored scientific posters on myasthenia gravis treatment costs and the Reveos system—the first FDA-cleared platform in the U.S. for automated whole blood processing and platelet separation; presented at national conferences.
  • Compiled and provided summary of market share, utilization, and nurse labor data that supported reimbursement proposals to CMS.
  • Engaged with payers, consultants, societies, and customers to address barriers in the healthcare landscape and build partnerships.
  • Led internal education on national coverage for apheresis, resolving a long-standing organizational concern.

Grievance and Appeals Analyst

Anthem, Inc. (now Elevance Health, Inc.)
04.2021 - 10.2022
  • Managed appeals and grievances from customers, providers, and legal representatives for more than 100 different types of Anthem medical insurance plans.
  • Completed thorough investigations that involved interpreting insurance policies, Employee Retirement Income Security Act (ERISA) provisions, Medicare rules, and federal mandates; validated claim pricing to ensure accurate and compliant decisions.
  • Drafted legally sound decision letters. Closed 130+ cases per month while maintaining exceptional accuracy.
  • Achieved 100% quality scores in Q3 and Q4 of 2021 as a new analyst.
  • Selected to manage high-scrutiny accounts.


Consumer Service Associate

Anthem, Inc. (now Elevance Health, Inc.)
10.2017 - 04.2021
  • Handled live chats and up to 45 calls daily to educate customers on healthcare services and plan benefits.
  • Received 205 customer surveys in 2020 with 97% satisfaction and 91% inquiry resolution.
  • Resolved complex claim rejections through strong communication, continued monitoring, cross-functional coordination, and external outreach.
  • Managed and uploaded legal documents for the team, including authorizations and certificates.
  • Trained new hires and created internal tools, including an Excel reference guide that improved team performance.

Physicians Clinics Central Scheduler

Boulder Community Health
06.2017 - 10.2017
  • Screened inbound calls quickly to schedule patients for office visits, immunizations, labs, and physical exams.
  • Identified emergencies; summarized symptoms for triage nurses.
  • Developed and maintained the master flu shot schedule across all primary care practices at Boulder Community Health.

Client Support Specialist

National Jewish Health
10.2016 - 06.2017
  • Advised clients on sample collection and shipping requirements for a wide range of lab tests.
  • Communicated test and sample issues, and documented correspondence in EMR.
  • Entered test orders, sent results, and printed specimen tube labels.
  • Reduced ordering errors and unnecessary lab work by identifying patterns that led to lab menu updates; created job aids to promote best practices.

Unit Coordinator

National Jewish Health
03.2014 - 10.2016
  • Supported daily operations in the Infectious Disease unit; floated to other units as needed and adapted quickly to different clinical workflows, teams, and patient populations as a floating Unit Coordinator.
  • Monitored patient flow and maintained real-time updates.
  • Organized medical records of potential patients to assist with scheduling decisions; retrieved missing information or prior test results when necessary.
  • Handled administrative and logistical tasks, including preparing discharge packets, billing, maintaining well-stocked patient rooms, and communicating with the pharmacy about orders.
  • Collected patient and family feedback to help with quality assessment and employee recognition.
  • Information Guide for out-of-state patients.

Education

Master of Public Health -

Southern New Hampshire University
Manchester, NH
10-2022

Bachelor of Science - Biology

Metropolitan State University of Denver
Denver, CO
12-2014

Summary

Detail-oriented healthcare professional with 10+ years of experience across the healthcare ecosystem and a strong foundation in research, reimbursement, and public health. Skilled in real-world data analysis and cost modeling, with a talent for transforming complex or fragmented information into compelling visuals and insights that support patient access to innovative therapies. Known for sharp communication, resourcefulness, and a knack for connecting the dots to establish alignment and solve complex challenges.

Timeline

Market Access Specialist

Terumo Blood and Cell Technologies, Inc.
10.2022 - 04.2025

Grievance and Appeals Analyst

Anthem, Inc. (now Elevance Health, Inc.)
04.2021 - 10.2022

Consumer Service Associate

Anthem, Inc. (now Elevance Health, Inc.)
10.2017 - 04.2021

Physicians Clinics Central Scheduler

Boulder Community Health
06.2017 - 10.2017

Client Support Specialist

National Jewish Health
10.2016 - 06.2017

Unit Coordinator

National Jewish Health
03.2014 - 10.2016

Master of Public Health -

Southern New Hampshire University

Bachelor of Science - Biology

Metropolitan State University of Denver
Darleny Lee, MPH