Gerren Gordon
Coolidge,AZ
Overview
12
12
years of professional experience
Work History
Case Manager
Occam Health Services
Sterling, VA
02.2023 - Current
- Conduct benefit investigations and assist patients with case status.
- Maintain up-to-date case records with case activity status.
- Adhere to ethical principles and standards to protect clients' confidential information.
- Assist individuals with eligibility for available benefits.
- Manage caseloads effectively, ensuring timely documentation and reporting.
- Conduct initial assessments to determine client eligibility for programs and services.
- Assist healthcare providers with program processes.
- Work with third party entities to obtain prior authorizations and appeal status.
- Determine patient out-of-pocket costs and affordability.
- Report adverse patient effects.
Benefits Coordinator Level 2
Ironwood Cancer Research Centers
03.2020 - 02.2023
- Review patient medical benefits to create patient cost estimates
- Review cost estimates and benefits structures with patients
- Review claims ledger for balances and credits
- Create daily logs and spreadsheets
- Effective time management skills to meet deadlines
- Providing accurate information to patient and health care provider
- Assist patients with financial hardships through grants and copay card programs.
Case Manager / Point of Contact
Mckesson
08.2016 - 10.2019
- Providing accurate and knowledgeable information to patient, health care providers and/or sales representatives
- Verifying Medical and Pharmacy coverage with coordination of benefits for physician offices and patients
- Knowledgeable in various pharmacy and medical insurance plans and benefit structures
- Working with several specialty pharmacy coordinators and Pharmacy benefit managers
- Responsible for updating internal data bases with new information
- Follow up with prescribers and sales representatives to ensure the patients case is completed and have received financial assistance and treatments
- Adhere to Client SLA (Service Level Agreement) established between company and drug manufacturer
- Buy and bill with ICD and CPT code experience with on and off label indications
- Manage 40+ patient cases daily to oversee procurement of specialty drugs
- Lead efforts in resolving claim denials on behalf of the member or providers First and third party billing
- Obtaining Prior authorizations and providing benefit summaries to physicians offices
- Being payer specific to the prior authorization procedures and documentation requirements
- Performed direct communication with physician offices in multiple states.
- Handling and resolving escalated issues
- Analyze prescription and medical claim for denials.
Benefits verification Rep
Caremark
11.2015 - 10.2016
- Subject Matter Expert
- Managed and assisted 20 agents
- Contact insurance companies to resolve Electronic Claim Submission (ECS) rejections and Major Medical coverage issues
- Perform quality monitoring of agents
- Evaluating coaching and providing direct feedback to agents
- Ensuring productivity is being met with agents
- Assist with continuous development and improvement within agents
- Respond to escalated customer situations
- Recommend and develop methods and procedures to maximize efficiencies
- Secure and verify a method of payment (MOP) for patient's financial responsibility to prevent company bad debt
- Review billing system (SPARCS) to verify patient's eligibility to receive medication and update necessary information
- Obtain accurate demographic, insurance and financial information from healthcare professionals and patients to complete enrollment applications for new patients
- Follow worklist prioritization of accounts as established by department policies and procedures for resolving accounts and/or submitting claims
- Contact payers and patients when necessary
- Comply with and adhere to all regulatory compliance areas, policies and procedures including HIPAA and PCI compliance requirements
- Other duties and projects as assigned.
Senior Billing & Enrollment MSR
United healthcare Military and Veterans
03.2013 - 11.2015
- Help customers resolve issues via phone
- Verify coverage/plan types with providers
- Take payments
- Setup Auto-payments
- Research billing discrepancies
- Maintain customer records
- Explain benefits plans
- Provide high quality customer service
- Effective time management skills to meet deadlines
- Research customer issues in a national data base
- Professionally consult with other companies and other departments
- Time management and adherence to schedules
- Work independently while making sound business decisions
- Navigate multiple company systems within multiple screens in a fast paced environment
- Enroll beneficiaries in healthcare plans
- Navigate a computer while on the phone
- Understand multiple products and multiple levels of benefits
- Working knowledge of Coordination of Benefits
- Experience with and working knowledge of HIPAA
- Physician assignments
- Maintain timely, accurate documentation for all appropriate transactions
- Assist customers with complex billing disputes.
Pharmacy Claims Representative
Catamaran(PBM)/Aerotek
12.2012 - 03.2013
- Effective time management skills to meet deadlines
- Call external business to have claims reprocessed
- Clear errors with failed claims
- Run test claims in RxClaims
- Adjudicating claims and healthcare claim review
- Analyze and research denied prescription claims.
Education
High School Diploma -
Marcos De Niza
Skills
- Computer system applications and navigation: Argus, RxClaim, Verint, SPARCS, ROAR, Microsoft Office: Word, Excel, Outlook, 10-key
- Insurance plan and benefit structures
- Front Office/Desk and Guest Service
- Data Entry
- ICD-10
- Leadership and management skills
- Claims Processing and Reimbursement specialist
- Critical thinking and customer service
Timeline
Case Manager
Occam Health Services
02.2023 - Current
Benefits Coordinator Level 2
Ironwood Cancer Research Centers
03.2020 - 02.2023
Case Manager / Point of Contact
Mckesson
08.2016 - 10.2019
Benefits verification Rep
Caremark
11.2015 - 10.2016
Senior Billing & Enrollment MSR
United healthcare Military and Veterans
03.2013 - 11.2015
Pharmacy Claims Representative
Catamaran(PBM)/Aerotek
12.2012 - 03.2013
High School Diploma -
Marcos De Niza
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