Summary
Overview
Work History
Education
Skills
Accomplishments
training
Languages
References
Timeline
AdministrativeAssistant
Erika Loza

Erika Loza

Summary

Highly organized and self-motivated professional experienced in project management, team development and process improvement. Skilled in developing and implementing strategies to increase efficiency and performance. Passionate about driving business growth and creating positive work environment.

Overview

11
11
years of professional experience

Work History

Patient Engagement Associate Director

Ultragenyx
03.2021 - Current
  • Oversaw and managed day-to-day operations for fully launched patient support programs, ensuring seamless execution and optimal program performance. Demonstrated proficiency in coordinating operational activities to enhance program effectiveness and deliver a high level of support to patients.
  • Acted as a day-to-day liaison between field teams, marketing and sales managers, and various stakeholders. Managed and resolved escalated issues, demonstrating effective communication and problem-solving skills. Maintained strong working relationships to ensure smooth collaboration and timely resolution of challenges.
  • Delivered regular updates and in-depth analysis of patient programs to Senior Director of Patient Servies, facilitating informed decision-making and strategic planning
  • Played a key role in assisting and leading the development of patient support programs within the UltraCare. Achieved a positive customer experience through the implementation of these programs, showcasing effective leadership and contribution to overall brand success.
  • Spearheaded the implementation of innovative access initiatives and programs, contributing to enhanced services and operational efficiency
  • Conducted comprehensive review and analysis of data reporting, identifying issues, trends, and potential interventions. Applied insights to ensure program excellence and drive continuous improvement in outcomes.
  • Maintained continuous communication with Commercial Analytics and Commercial IT, ensuring seamless integration with internal CRM. Oversaw UCG reports and monitored account activity tracking to facilitate efficient coordination and enhance data-driven decision-making processes
  • Collaborated closely with the Market Access Marketing/Brand Marketing team to identify and implement promotional collateral aimed at delivering value to the patient community. Demonstrated effective partnership in aligning marketing strategies with the needs of the target audience.
  • Ensured alignment of programs and materials with directives from the Medical, Legal & Regulatory and Promotional Review Committee. Demonstrated commitment to compliance and adherence to regulatory standards in all aspects of program development and promotional content.
  • Ensured accurate capture of relevant data in the PRM system by overseeing and guiding Case Managers in maintaining precise records
  • Provided regular reporting metrics to track and ensure timely progression of all cases, contributing to the overall effectiveness of the program.
  • Facilitated weekly or bi-weekly 1:1 meetings with Case Managers to provide ongoing support, address challenges, and enhance overall team performance
  • Ensured program compliance with business rules and operational procedures through regular auditing of cases and phone calls, maintaining a high standard of quality and adherence to established protocols.
  • Managed daily interactions and fostered strong relationships with specialty pharmacies, ensuring effective collaboration and streamlined communication channels.
  • Monitored Key Performance Indicators to assess and enhance operational performance, facilitating data-driven decision-making processes.


Patient Engagement Manager

Ultragenyx
08.2018 - 03.2021
  • Championed the role of patient advocate, fostering collaborative relationships among payers, healthcare providers (HCP), and patients to ensure a holistic approach to care.
  • Exhibited meticulous attention to detail by collecting and rigorously reviewing all patient insurance benefit information, ensuring accuracy and completeness in data management.
  • Took a proactive role in patient education, providing comprehensive information and assistance to navigate the reimbursement process, thereby enhancing overall patient experience.
  • Assumed responsibility for tracking and following up on prior authorization and appeal requests, demonstrating a commitment to resolving issues promptly and ensuring a streamlined process.
  • Collaborated effectively with Specialty Pharmacy and insurance companies to obtain vital reimbursement information, contributing to optimized outcomes for patients and healthcare providers.
  • Maintained and updated detailed case histories for all assigned patients in the PRM system, ensuring a comprehensive and organized record of patient interactions and interventions.
  • Conducted regular monthly adherence checks to assess patient adherence levels, taking proactive measures to ensure the best possible therapy outcomes.
  • Served as a dedicated Specialty Pharmacy liaison, establishing front-line communication with CVS Specialty Pharmacy. Provided invaluable assistance to Case Managers with follow-ups and handled escalations with a focus on efficient issue resolution.

Team Lead

CareMetx LLC
06.2017 - 08.2018
  • Led and directed a dynamic team of ten case managers and two reimbursement specialists, creating a collaborative and high-performing work environment that achieved operational excellence.
  • Conducted monthly audits for quality assurance, delivering comprehensive feedback to each case manager to drive continuous improvement and ensure consistently high-quality outcomes.
  • Assessed team performance metrics rigorously, guaranteeing the timely resolution of all cases and proactively addressing challenges to meet or exceed established turnaround time goals.
  • Analyzed detailed reports for emerging trends and provided strategic recommendations to management, contributing valuable insights for program optimization.
  • Demonstrated a proactive approach in identifying program issues, proposing effective solutions, and working collaboratively with the team to implement improvements, ultimately enhancing program efficiency and effectiveness.
  • Played a pivotal role in developing comprehensive program training documents, ensuring team members were equipped with up-to-date knowledge and skills, thereby contributing to professional development.
  • Contributed significantly to the review and implementation of process flows and Standard Operating Procedures (SOPs) for the program, aligning operations with best practices.
  • Monitored team job performance to ensure adherence to program guidelines and Service Level Agreements (SLAs), consistently achieving and exceeding performance targets.
  • Provided hands-on day-to-day instruction and coaching to the team, fostering a culture of continuous learning and growth.
  • Assumed a critical role in resolving complex patient reimbursement issues, applying problem-solving expertise and maintaining a strong commitment to patient advocacy.

Reimbursement Case Manager

CareMetx LLC
11.2016 - 06.2017
  • Served as a dedicated Case Manager for the Puerto Rico Region, overseeing cases for therapies including Kuvan, Naglazyme, and Vimizim, which provided therapies for patient with Rare Disease.
  • Provided crucial back-up coverage for other Case Managers, ensuring seamless continuity of support and service.
  • Collaborated closely with patients and their families, guiding them through all necessary steps to gain access to therapy and facilitating a smooth experience.
  • Championed patient advocacy, enhancing collaborative relationships among payers, healthcare providers (HCP), and patients to ensure comprehensive and patient-centered care.
  • Collected and meticulously reviewed all patient insurance benefit information, ensuring accuracy and completeness in data management.
  • Took a proactive role in patient education, providing comprehensive information and assistance to navigate the reimbursement process, contributing to a streamlined and informed patient experience.
  • Tracked and followed up on prior authorization and appeal requests when necessary, demonstrating a commitment to timely issue resolution.
  • Identified and facilitated referrals to alternative coverage options and financial assistance programs for patients who were underinsured or required copay assistance, contributing to improved access to therapy.
  • Conducted monthly adherence checks to ensure the best possible outcome of therapy, proactively addressing any adherence-related issues.

Reimbursement Specialist

Lash Group
04.2015 - 11.2016
  • Proficient in all aspects of medical reimbursement, benefit investigation, payer reimbursement policies, regulatory and administrative rules, with strong emphasis on obtaining specialty pharmacy benefits, and part D prescription drug coverage benefits
  • Excellent investigational and analytical skills, and a proven ability to communicate results effectively in both written and/or verbal format
  • Thorough attention to detail and process
  • Ability to manage multiple tasks within required performance standards and deliver on deadline
  • Excellent knowledge of the managed care industry, including government payers, as well as in-depth understanding, and working knowledge of the commercial payer landscape
  • Effective interpersonal skills, with a proven ability to work well under pressure
  • Investigate patient's insurance benefits for 3 ultra-rare disease for BioMarin: Kuvan, Naglazyme, & Vimizim
  • Identify network providers, provider restrictions, co-pay / deductible / out of pocket cos, and documentation requirements for prior authorizations/ medical review process and re-certification periods
  • Reports any reimbursement trends/delays to supervisor (e.g
  • Billing denials, claim denials, pricing errors, payments, etc.) Aided physician office staff and patients to complete and submit all necessary insurance forms and program applications
  • Assist clinics with processing prior authorizations
  • Track and follow-up on prior authorization and communicate approval and denials to case manager and clinics.

Program Support

Lash Group (Insight Global Temp. Agency)
09.2014 - 04.2015
  • Manage intake of all programs specific correspondence including mail and faxed documents
  • Perform general administrative tasks
  • Maintains and promotes positive and professional working relationships with associates and management
  • Handles incoming and outgoing phones for the department and responds to questions and/or requests in a Professional manner
  • Maintains and promotes positive and professional working relationships with associates and management.
  • Maintained strict confidentiality of sensitive patient data, adhering to HIPAA regulations and organizational policies.

Medical Assistant / Medical Receptionist

West Bay Orthopedic Medical Group Inc.
01.2013 - 09.2014
  • Improved patient experiences by efficiently managing appointments and maintaining organized medical records.
  • Enhanced clinic efficiency by assisting physicians with routine procedures and diagnostic tests.
  • Assisted in the development of clinic policies and procedures to ensure compliance with industry standards and regulations.
  • Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.
  • Built strong relationships with patients through effective communication skills that foster trust in the clinic's commitment to quality care.
  • Streamlined prior authorization processes by implementing efficient tracking systems.
  • Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
  • Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
  • Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
  • Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.

Education

No Degree - Medical Assistant

Boston Reed
South San Francisco, CA
01.2013

Skills

  • Program Development
  • Strategic Leadership
  • Team Collaboration and Leadership
  • Relationship Building
  • Analytical Thinking
  • Systems Development
  • Project Coordination
  • Operations Management
  • Legal and Regulatory Compliance
  • Hiring and Retention
  • Process Improvement
  • Business Planning

Accomplishments

    Top UltraCare Guide of 2019

    Issued by Ultragenyx · Mar 2020

    Case manager of the year 2017

    Issued by Caremetx/BioMarin · Mar 2018

training

Participated in time management workshops, acquiring valuable tools and techniques to optimize productivity.

Completed numerous seminars in customer service, gaining expertise in delivering exceptional service and building positive customer relationships.

Engaged in leadership seminars to develop strong leadership skills and foster team collaboration.

Languages

Spanish
Native or Bilingual

References

References available upon request.

Timeline

Patient Engagement Associate Director

Ultragenyx
03.2021 - Current

Patient Engagement Manager

Ultragenyx
08.2018 - 03.2021

Team Lead

CareMetx LLC
06.2017 - 08.2018

Reimbursement Case Manager

CareMetx LLC
11.2016 - 06.2017

Reimbursement Specialist

Lash Group
04.2015 - 11.2016

Program Support

Lash Group (Insight Global Temp. Agency)
09.2014 - 04.2015

Medical Assistant / Medical Receptionist

West Bay Orthopedic Medical Group Inc.
01.2013 - 09.2014

No Degree - Medical Assistant

Boston Reed

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Erika Loza