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
undefinedAccomplishments
· 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
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