Francesca Allen
Denham Springs,LA
Summary
Experienced Field Reimbursement Specialist with a strong background in women's health, obesity, neurology, endocrinology, psychiatry, respiratory, and dermatology. Offering over 15 years of comprehensive reimbursement support for specialty medications. Proven track record of problem resolution, customer satisfaction enhancement, and operational improvement. Recognized as a quality-driven Reimbursement Specialist excelling in healthcare provider office assistance and essential training. Meticulous approach ensures accurate patient account review and efficient issue resolution.
Overview
11
11
years of professional experience
Work History
Transitional Care Coordinator
Humana Behavioral Health
06.2023 - Current
- Resolving barriers that hinder effective care within the Therapeutic areas of Neurology Substance Abuse and Psychiatry
- Interface appropriately with insurance administrators, physicians' offices, patients, and internal personnel.
- Oversee member Transition and Discharge Planning activities whom are between healthcare settings and/or new to the plan.
- Reimbursement Support Services, Benefit Verifications, Prior Authorizations, Appeals Assistance, and Quality Assurance.
- Reviewing patient insurance benefit options. Validating prior authorization requirements identifying alternate funding/financial assistance programs
- Educating physician office staff on the use of the client’s patient assistance and reimbursement support services including web-based provider programs. Providing information on relevant reimbursement topics related to client’s products
- Billing and Coding Support; Patient Assistance and Drug Replacement. Assistance in locating coverage for uninsured and underinsured patients, Free Drug Programs.
- Triaging Mental Health/ Psychiatry and Substance Abuse cases Telephonically Throughout the state while acting as an extension of the call center and/or HUB while providing live one-on-one coverage support with HCP’s Utilization Review depts and or Clients
- Responsible for driving accuracy and quality assurance, compliance with all established policies and procedures, and sound documentation for all activities.
- Operated with high integrity, built trust, and earned sustained credibility with internal and external clientele
- Buy and Bill Reimbursement Support
Telephonic Reimbursement Coordinator
Humana
10.2020 - 06.2023
- Resolving barriers that hinder effective care within the Therapeutic areas of Endocrinology Neurology Respiratory and Obesity
- Provide ongoing Virtual program and service education to providers, clients and client supports; while promoting member self-care through Motivational Interviewing
- Act as an extension of the call center and/or HUB and provide live one-on-one coverage support while identifying additional benefits; community resources, and assist in pull through to ensure members’ healthcare needs are met
- Working with Team Managers and Leads to drive Team productivity and metrics to support individual performance
- Scheduling the needs of qualifying members with DME and Health resources (Meals Providers Transportation) in efforts to assist with Patient Pull Through
- Assisting with prior authorizations, as well as appeals and grievance processes as well a Critical incident reporting
- Medicare Medicaid Dual Enrollment Eligibility
- Maintain a working knowledge of Federal and State regulations, including the Anti-Kickback Statute,Stark Law, and HIPAA, as well as Intra-organizational policies and procedures
- Design training for the team; seek ways to improve the training/onboarding process; identify mentors for new hires
Feild Care Reimbursement Coordinator
Humana
07.2013 - 09.2020
- Resolving barriers that hinder effective care within the Therapeutic areas of Dermatology Obesity Neurology Women’s Health and Respiratory
- Acting as an Account Manager serving as a liaison between client and provider within assigned territory
- Utilization Review assistance/ Pull through
- Practicing proactive scheduling; create routing plans for field days; leaving flexibility for reactive visits/routing to effectively manage assigned territory /workload
- Review patient-specific information in reimbursement cases where the office has specifically requested assistance in resolving access issue while acting Act as an extension of the call center and/or HUB and provide live one-on-one coverage support
- Provide ongoing program and service education to providers, clients and client supports; while promoting member self-care through Motivational Interviewing
- Assisted Living Facilities and Skilled Nursing Facilities Offering office education during enrollment process
- Identify additional benefits; community resources, and assist in pull through to ensure members’ healthcare needs are met making referrals as needed
- Assess clients for unmet healthcare needs, as well as facilitate, coordinate, and manage patient access with par; non-par providers
- First point of contact for the elderly regarding Florida’s Long Term Managed Care
- Interface appropriately with insurance administrators, physicians' offices, patients, and internal personnel. Reimbursement Support Services, Benefit Verifications, Prior Authorizations, Appeals Assistance
- Observed strict procedures to maintain data and plan participant confidentiality.
- Trained new team members in policies and procedures and offered insight into the best ways to manage job tasks and duties.
- Explained benefits to plan participants in easy-to-understand terms in order to educate each on available options.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.
- Assistance in locating coverage for uninsured and underinsured patients, Free Drug Program, and foundations.
Education
Bachelor of Science - Criminology
Florida State University
Tallahassee, FL12-2012
Skills
- Disease specialization proficiency Healthcare billing proficiency
- Strong medical ethic Problem resolution ability
- Obesity, Psychiatry, Women's Health, Dermatology Respiratory and Neurology Support
- Medicare Part A, B, C, D, and Commercial payer knowledge
- Medicare- Medicaid - Duals Knowledge
- Specialty Pharmacy process and provider support
- Hub Management and collaboration on reimbursement level
- Self-motivated
- Process implementation
- Team liaison
- Claims investigation and research
- Specialty Pharmacy Billing
- Effective communication skill
- Relationship building
- Stakeholder relations
- Client account management
- Chronic Disease Management
- Strong written and verbal communication skills
- Working well independently
- Effective Multi- Tasker
- Team building skills
- Buy and Bill experience in all healthcare settings
- Territory Management (Multiple State Coverage on a six-week rotation)
- Self Starter, seeker of solutions, and answers
- Culture-focused and dedication
Additional Information
I think I could better more positively impact the Teams performance by covering the Florida Gulf Coast, lower Georgia, north Louisiana, Alabama and Mississippi areas as I am more familiar with these territories.
Timeline
Transitional Care Coordinator
Humana Behavioral Health
06.2023 - Current
Telephonic Reimbursement Coordinator
Humana
10.2020 - 06.2023
Feild Care Reimbursement Coordinator
Humana
07.2013 - 09.2020
Bachelor of Science - Criminology
Florida State University
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