Dreama S. Mundy
PBM Med D Professional
Willard,Ohio
Summary
Enthusiastic Professional with 12 years of Medical Administration/Medical Office background with a focus on Med D (PBM) industry. Trained in specifics of many areas of health insurance including billing, prior authorizations, and CMS guidance. Empathy and practicality balance learned from real time experience with patients in a medical doctor office. Professionalism developed from years of building p customer relationships.
Overview
10
10
years of professional experience
1
1
year of post-secondary education
Work History
Account Manager
ELIXIR SOLUTIONS
Twinsburg, United States
05.2021 - 01.2022
- Medicare Part D Reporting Requirements and Data Validation Part D Coverage Determinations
- Appeals & Grievances - CMS Web Based Training
- Secured high-value accounts through consultative selling, effective customer solutions and promoting compelling business opportunities.
- Sold new products and services and developed new accounts to maximize revenue potential.
- Listened attentively to client feedback to create stronger relations and shape business.
- Introduced new processes to improve data analysis.
- Liaised with external customers and internal departments to provide and gather information enabling customer requirements to be met.
- Addressed problems with accounting, billing and service delivery to maintain and enhance client satisfaction.
- Facilitated client satisfaction and renewed customer relations to drive growth.
- Educated clients on new products or services to increase customer engagement with brand.
- Analyzed account details such as usage, sales data and client comments to enhance understanding of effectiveness and client needs.
- Managed book of business to maintain positive relationships and make effective financial or client-related decisions.
Account Manager Assistant
ELIXIR SOLUTIONS
Twinsburg, OH
02.2016 - 03.2021
- Assist Client & Customer Service Department with claim research
- Analyze issues with adjudication and create a plan within relative departments for corrections
- Drove sales by developing exceptional customer rapport to foster satisfaction
- Proposed available products and solutions to meet diverse requirements
- Communicated updates regarding current projects and ongoing concerns within departments
- Schedule and organize weekly Client meetings
- Offer guidance to client while setting up contract needs for meet CMS guidelines and requirements.
- Anticipated clients' needs by staying in touch on regular basis.
- Worked diligently to resolve unique and recurring complaints, promoting loyalty and enhancing operations.
- Built client relationships by acting as liaison between customer service and sales teams.
- Evaluated costs against expected market price points and set structures to achieve profit targets.
- Effectively led seasoned team of partner managers and account coordinators.
- Consulted with clients after sales and contract signings to resolve problems and provide ongoing support.
- Analyzed and reported on customer activity, business trends and areas of concern.
- Consulted with businesses to supply accurate product and service information.
- Presented professional image consistent with company's brand values.
- Maintained current knowledge of evolving changes in marketplace.
- Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas.
- Gained customer trust and confidence by demonstrating compelling, persuasive and composed professional demeanor.
- Audit assistance as required.
- Retro LIS refund reporting submission.
Clinical Care Coordinator
ELIXIR SOLUTIONS
Twinsburg, OH
02.2015 - 01.2016
- Developed and updated tracking spreadsheets using Excel
- Generated reports of findings to help management with making key decision
- Provided data for various CMS Audits
- Communicate and work with other company teams to plan, implement and test to assure accuracy in plan
- Assist the IT department implementation by providing necessary documents necessary to complete task
- Collected, arranged and enter information to program and update claim adjudication system as updates are needed
- Assist with CMS audits
- Report ordering from system and organize on custom Excel Spreadsheet for client updates
- Lead teams when necessary for larger projects
- Customer spreadsheets created using Excel for companywide usage (Client Spec Sheet, PA Requirements)
- Work with IT to manually test and programing for each monthly formulary.
- Oversaw quality assurance programs to enhance performance and consistently achieve superior care standards.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Maintained compliance with patient privacy and security regulations such as HIPAA.
- Tracked referral submission during facilitation of prior authorization issuance.
- Verified eligibility and compliance with authorization requirements for service providers.
- Researched denied claims and contacted care takers to resolve these issues.
- Researched denied claims to resolve these issues.
- Escalated requests for non-standard services to meet Med D timeline requirements.
- Reviewed insurance coverage for patients to determine which party was liable for payment.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Interviewed applicants and explained scope of different available benefits.
- Documented all communication with applicants and inputted information into system using Pharmscreens.
Temps Operations Specialist
Alliance Health
Mayfield Heights, OH
08.2014 - 02.2015
- Research, locate and collect health records for use in litigation process by communicating using phone, internet & email.
Med D Claims Processor
Choice 1 Staffing
Solon, OH
12.2013 - 08.2014
- Followed quality standards and procedures to minimize errors and maximize customer satisfaction
Medical Assistant/ Medical Administrative Office Assistant
New Beginnings Pediatrics
Norwalk, OH
09.2011 - 11.2013
- Insurance validation and precertification
- Completed clinical procedures and gathered patient data for interpretation by physician
- Maintained detailed records of test results by entering data and patient information into computer
- Communicated clearly and effectively with patients to verify information, determine purpose of visit and record medical history
- Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus
- Prepared patients for X-rays, electrocardiograms, suture removal and dressing changes
Education
Technical Diploma - Medical Assistant
Ohio Business College
Sheffield Lake, OH 01.2009 - 09.2009
Technical Degree - Medical Administration
Ohio Business College
Sandusky, OH 06.2008 - 12.2008
Skills
National accounts
Account verification
Team Training
Operations
Account management
Coordinating documents
Goals and performance
Account oversight
Relationship building and management
Microsoft Excel expertise
Microsoft Word expertise
Microsoft Outlook expertise
Systems and software programs
Customer rapport
Med D Expertise
Management collaboration
Accomplishments
· 2021 Receptor of “Making Lemonade from Lemons” award at company wide Client Services meeting.
· Participated in the 2020 Work place reimagined summit. Creation and delivery of presentation supporting a healthy work space at home.
· 2019 Medicare Part C and Part D Reporting Requirements and Data Validation Part D Coverage Determinations
· Appeals & Grievances Annual CMS Web Based Training 2017-2019
· On Line Training: Account Management Project Management Coverage Determination, Grievances and Overrides Setting and Managing Priorities
· Well versed in the basics of LEAN systems.
Certifications: Medical Assistant (Allied Health) Red Cross CPR.
Timeline
Account Manager
ELIXIR SOLUTIONS
05.2021 - 01.2022
Account Manager Assistant
ELIXIR SOLUTIONS
02.2016 - 03.2021
Clinical Care Coordinator
ELIXIR SOLUTIONS
02.2015 - 01.2016
Temps Operations Specialist
Alliance Health
08.2014 - 02.2015
Med D Claims Processor
Choice 1 Staffing
12.2013 - 08.2014
Medical Assistant/ Medical Administrative Office Assistant
New Beginnings Pediatrics
09.2011 - 11.2013
Technical Diploma - Medical Assistant
Ohio Business College
01.2009 - 09.2009
Technical Degree - Medical Administration
Ohio Business College
06.2008 - 12.2008