Diana Drake

Core Responsibilities:

Manage a high volume of incoming calls, ensuring prompt and professional responses to customer inquiries and issues
Benefits Investigation and Prior Authorization:
Investigating patient benefits, resolving prior authorization issues, and identify potential barriers to medication access, including refill too soon, vacation, and plan limitations.
Financial Assistance:
Research and connect pharmacies with patient's financial assistance programs to help cover medication costs. Work closely with the Centers for Medicare/Medicaid to ensure compliance.
Interpreting Treatment Plans:
Analyze patient's drug coverage treatment plans, advise pharmacies of benefit plan expectations for quantity, days supply, drug limitations to prevent interruption in therapy by identifying any potential issues or areas for improvement.

Verify and document patient insurance eligibility and benefits for various services.

Identify specialty medication requests and process procedures to ensure proper dispensing guidelines are met.
Communicate with Healthcare Professionals:
Collaborate with nurses, providers, benefit verification representatives and physicians to address potential barriers to treatment and ensure coordinated care. Verify and document patient insurance eligibility and benefits for various services.

Knowledge of Insurance and Reimbursement Methodologies:

Understanding how insurance plans work, including different types of benefits, copays, and coordination of benefits.

Cross-Team Collaboration

Train agents on best practices for handling difficult conversations, resulting in improved team performance during challenging interactions.

Adaptability and Ability to Learn:

Staying up-to-date on changes in pharmacy benefits and regulations

Engage in and maintain regular communication with physicians, benefit office staff, pharmacy personnel, client managed prior authorization staff, and specialty pharmacies., to support, document, and coordinate patient benefit information to process rejected claims and eligibility issues.

Provided phone support and education to junior pharmacy help desk agents to maintain compliance, reduce all times and ensure proper procedures and policies were met.

Assist pharmacies in reprocessing and investigating rejected claims for medications for pharmacy patients.

Manage and maintain patient pharmacy claim records, adhering to HIPAA guidelines and ensuring confidentiality and accuracy.

Skilled at working independently and collaboratively in a team environment.

Proven ability to learn quickly and adapt to new situations and software applications.

Collaborated with healthcare providers to resolve medication discrepancies, resulting in improved patient care.

Demonstrated empathy and professionalism while handling sensitive patient information and concerns.

Contributed to the team''s success by exceeding call center performance metrics consistently.

Supported quality assurance initiatives by adhering to company policies and procedures throughout all interactions.

Exceeded personal goals related to productivity, adherence, quality scores, and overall performance evaluations.

Participated in ongoing training programs to stay current on industry trends, regulations, and company updates.

Responded to customer requests, offering excellent support and tailored recommendations to address needs..

Proficiently utilized various computer applications including Microsoft Office, Webex, Citrix, Teams and custom software.