Emily Koritsky
Pittsburgh,PA
Summary
Professional with strong background in care coordination. Skilled in patient advocacy, healthcare planning, and resource management. Known for effective team collaboration and achieving measurable results. Adaptable to changing needs with robust communication and organizational skills. Reliable and focused on delivering high-quality care outcomes.
Overview
3
3
years of professional experience
Work History
Care Coordinator
PANTHERx Specialty Pharmacy
03.2024 - Current
- Communicates with patients via phone to establish rapport, introduce program offerings, customize welcome kit, ensure clinical compliance, authorize next shipment of medication, and coordinate any other patient engagement activities
- Conducts physician office welcome call to provide overview of the program and complete enrollment in physician office communication preference plan
- Tracks all interactions with patients and manufacturer representatives, utilizing mutually agreed upon platforms, to the extent permitted by law
- Serves as the primary contact for the patient and physician to resolve inquiries
- Ensures patients are enrolled and consented with the program and communicate with manufacturer representatives as needed
- Performs all required order management activities such as order/data entry, patient onboarding, profile creation, prescription retrieval, adverse event and product compliant submission and reconciliation, and assigned follow-ups
- Enrolls patients in financial assistance programs as appropriate including Quick Start, Bridge, Copayment Assistance, PAP and Product Replacement if applicable
- Communicates to patients that they are referring the patient to an independent organization independent from the manufacturer, upon a patient transfer to third-party PAPs for assistance
- Conducts all patients and physicians facing interactions related to reimbursement support, including but not limited to processing pharmacy claims, obtaining authorizations and overrides as needed and discussing financial responsibility with patients
- Communicates effectively with both the Pharmacist Supervisor and Program Manager and performs other duties assigned
- Manages patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
- Uses company software and databases to maintain records of services performed and patient conditions.
Claims Analyst
PANTHERx Rare Specialty Pharmacy
06.2023 - 03.2024
- Verified patient pharmacy and medical coverage & processing info
- Processed pharmacy claims on the patient’s behalf through a pharmacy benefit system
- Obtained authorizations & overrides as needed
- Applied patients for copay cards and/or assistance programs
- Investigated and resolved patient cases
- Discussed with patients to review patient financial responsibility, obtain patient consent and payment
- Ensured proper shipment set up
- Worked special projects and evening shifts to assist with all available therapies
- Directed staff with insurance related situations and issues accordingly
Medical Assistant
Keystone Pain Consultants
03.2023 - 06.2023
- Assisted clinicians when providing care to patients
- Administrative and clinical tasks such as maintaining patient records, scheduling appointments, rooming patients, chart preparation, checking vitals, carrying out drug tests, and preparing exam rooms
- Assisted patients and providers by directing and providing information for their needs
- Initiate and maintain correspondence with patients and insurance companies
- Prioritized workflow and tasks to assure the best possible productivity for both the office and patients
Complaints and Grievances Intake Coordinator
UPMC Health Plan
07.2022 - 03.2023
- Managed accurate and timely case entry into the C&G information system
- Accurately maintained C&G data files
- Conducted case intake process, via cases received through verbal and written requests, and set up new cases in the C&G information system
- Accessed multiple health plan systems to assist with case classification
- Identified and escalated priority and expedited issues to management in a timely manner
- Retrieved, copied, collated, and filed various documents associated with the complaints and grievances processes
Complaints and Grievances Coordinator
UPMC Health Plan
03.2022 - 07.2022
- Tracked and managed member complaints and grievances for the Medicare line of business
- Investigated member complaints and grievances and responded in writing according to department standards
- Ensured member concerns were thoroughly and accurately addressed according to regulatory guidelines
- Assisted in reporting complaint and grievance data to appropriate regulatory bodies and departments
- Effectively utilize internal and external Health Plan contacts, including Health Plan staff and providers, to help in this process
- Interpreted medical information, recognized trends, and identified opportunities for improvement
Education
Bachelor of Science - Psychology
University of Pittsburgh
04.2022
High School Diploma -
Montour High School
06.2016
Skills
- Proficient in Microsoft Office
- Time-Management
- Organizational
- Communication - Verbal and Written
- Problem-Solving
- Case management
- Documentation
- Patient education
- Organizational skills
- Medical terminology understanding
- Patient advocacy
- Claims processing
Timeline
Care Coordinator
PANTHERx Specialty Pharmacy
03.2024 - Current
Claims Analyst
PANTHERx Rare Specialty Pharmacy
06.2023 - 03.2024
Medical Assistant
Keystone Pain Consultants
03.2023 - 06.2023
Complaints and Grievances Intake Coordinator
UPMC Health Plan
07.2022 - 03.2023
Complaints and Grievances Coordinator
UPMC Health Plan
03.2022 - 07.2022
High School Diploma -
Montour High School
Bachelor of Science - Psychology
University of Pittsburgh
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