Heather M. McNulty
Abington,MA
Summary
Talented and passionate Patient Support/Case Manager with an exceptional acumen to guide top performing teams, generate new business, maintain customer satisfaction, and drive successful growth in highly competitive markets.
Proactive and versatile professional with a dedication to quickly adapting to new challenges. Strong problem-solving abilities and a proven track record of fostering strong relationships with clients and team members. Focused on supporting team success and achieving positive results.
Overview
18
18
years of professional experience
Work History
Senior Patient Support Manager
Takeda Pharmaceuticals
Lexington, MA
02.2022 - Current
- Assist and educate patients and healthcare providers on complex rare disease states, including hereditary angioedema (HAE), alpha-1 antitrypsin deficiency, lysosomal storage disorders (LSD), and short bowel syndrome (SBS).
- Provide comprehensive support regarding access to prescribed therapies, including prophylactic and acute HAE treatments (Firazyr, Kalbitor, Cinryze, Takhzyro), alpha-1 therapies (Glassia, Aralast), SBS therapy (Gattex), and LSD therapies (VPRIV, Elaprase).
- Partner closely with patients, providers, and payers to navigate coverage challenges, resolve access barriers, and ensure timely initiation and continuity of therapy.
- Deliver high-touch case management services, fostering strong relationships with patients and healthcare professionals while collaborating cross-functionally with internal and external stakeholders to provide best-in-class customer service and support.
Patient Support Manager
Takeda Pharmaceuticals
Lexington, MA
01.2019 - 02.2022
- Assist and educate patients and their providers on HAE and the access to associated prophylaxis and/or acute HAE therapies (Firazyr, Kalbitor and/or Cinryze) as prescribed by their physician.
- Work closely with patients, payers and providers through coverage barriers to ensure access to ongoing, uninterrupted therapy.
- Maintain relationships by providing professional case management services to patients, health care professionals as well as to internal and external customers for the purpose of providing best in class customer service.
- Graduated from intensive HAE/OnePath training program in July 2016.
- Assisted in the integration of HAE patients using Kalbitor obtain services through OnePath after the completed acquisition of Dyax Pharm.
- Oversee and manage HAE patients being treated and/or evaluated at several key allergy centers in the VA area.
- Assist office medical staff obtain prior approval, co-pay assistance, and administration training for HAE patients.
- Drive patient accruals and shipment data by entering and maintaining accurate records in OnePath database (SalesForce).
- Explain and educate HAE patients and medical professionals on OnePath services while troubleshooting and resolving reimbursement issues.
- Work closely with pharmacy hub (LASH) to ensure the process of patient referrals are completed in a timely manner.
- Attended and presented at Patient Programs providing an overview of OnePath and the services we offer HAE patients.
- Attended National HAE and ACAAI conferences, as well as yearly Shire National Sales Conferences.
- Follow all HIPAA regulations to ensure patient information is held to the highest confidentiality standards.
- Management of area KOL's, offering direct support to physicians and office support staff assist patients gain access to one and/or all of the HAE medications Shire manufactures.
- Drive pipeline to initiate patient accruals; including selecting appropriate medical services as well as building relationships with key opinion leaders (KOL's) and Centers of Excellence.
- Work closely with Sales, Marketing, Managed Markets, and Field Reimbursement Team(s) to ensure OnePath case managers and their partners are providing continuous best in class service and support to patients accessing our HAE therapies.
- Secure co-pay assistance through Shire's internal co-pay program and/or refer patients to alternative 501c(3) organizations as needed for each patient enrolled in OnePath for services.
- Act as department lead/liaison to our HUB during yearly benefit re-verification period.
Patient Support Manager
Shire Pharmaceuticals
Lexington, MA
06.2016 - 01.2019
- Assist and educate patients and their providers on HAE and the access to associated prophylaxis and/or acute HAE therapies (Firazyr, Kalbitor and/or Cinryze) as prescribed by their physician.
- Work closely with patients, payers and providers through coverage barriers to ensure access to ongoing, uninterrupted therapy.
- Maintain relationships by providing professional case management services to patients, health care professionals as well as to internal and external customers for the purpose of providing best in class customer service.
- Graduated from intensive HAE/OnePath training program in July 2016.
- Assisted in the integration of HAE patients using Kalbitor obtain services through OnePath after the completed acquisition of Dyax Pharm.
- Oversee and manage HAE patients being treated and/or evaluated at several key allergy centers in the VA area.
- Assist office medical staff obtain prior approval, co-pay assistance, and administration training for HAE patients.
- Drive patient accruals and shipment data by entering and maintaining accurate records in OnePath database (SalesForce).
- Explain and educate HAE patients and medical professionals on OnePath services while troubleshooting and resolving reimbursement issues.
- Work closely with pharmacy hub (LASH) to ensure the process of patient referrals are completed in a timely manner.
- Attended and presented at Patient Programs providing an overview of OnePath and the services we offer HAE patients.
- Attended National HAE and ACAAI conferences, as well as yearly Shire National Sales Conferences.
- Follow all HIPAA regulations to ensure patient information is held to the highest confidentiality standards.
- Management of area KOL's, offering direct support to physicians and office support staff assist patients gain access to one and/or all of the HAE medications Shire manufactures.
- Drive pipeline to initiate patient accruals; including selecting appropriate medical services as well as building relationships with key opinion leaders (KOL's) and Centers of Excellence.
- Work closely with Sales, Marketing, Managed Markets, and Field Reimbursement Team(s) to ensure OnePath case managers and their partners are providing continuous best in class service and support to patients accessing our HAE therapies.
- Secure co-pay assistance through Shire's internal co-pay program and/or refer patients to alternative 501c(3) organizations as needed for each patient enrolled in OnePath for services.
- Act as department lead/liaison to our HUB during yearly benefit re-verification period.
Medical Biller/Adjuster BCBS
SMG Compass Medical Group
Bridgewater, MA
01.2009 - 06.2016
- Post and/or review claims in an accurate and timely manner so as to maintain collections.
- Organize work area to ensure all pended claim review reports are easily accessible so that failed claims are resolved within filing limits.
- Post all insurance payments and patient payments in a timely manner; on floor resource and mentor.
- Verify and update patient demographic and insurance information to ensure clean claim submission to appropriate payer.
- Monitor claim statuses daily to ensure timely submission of all claims.
- Research and resolve all claim rejections and denials, and follow appropriate appeal process as needed.
- Notify provider offices of missing or incomplete information such as referrals and/or authorizations.
- Maintain communication with payer to understand claim denials so to determine the appropriate steps to resolve any and all claim discrepancies.
- Provide exceptional customer service to patients calling in with complex billing and claim submission questions.
- Consistently maintained a lower than average rate of under 20 days in A/R.
- Participated and lead discussions to streamline workflow process to improve efficiency and effectiveness.
- Assisted with training new employees on claim submission and denial resolution processes.
Medical Biller/Coder
Weymouth MRI
Weymouth, MA
01.2009 - 12.2009
- Part of a team that was responsible for the coding and claims submission of multiple MRI related procedures.
- Responsible for applying the appropriate diagnostic and procedural codes to individual patient health information for data retrieval, analysis and claims processing.
- Coded and filed radiology reports with the appropriate corresponding diagnoses.
- Routine follow up on paid/unpaid claims and posted patient and insurance payments as needed.
- Ensured pre authorization with insurance was in place prior to patient scheduled appointment.
- Answered all billing phone calls and managed/resolved any patient inquiries or concerns.
Medical Biller (contractor to permanent)
Claim Assist
Westwood, MA
01.2008 - 12.2009
- Responsibilities included, but were not limited to the timely submission of technical or professional medical claims to insurance companies.
- Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
- Checked claim status with insurance companies including but not limited to Tufts, Network Health, Blue Cross Blue Shield, MassHealth, Commonwealth Care, and Cigna.
- Called insurance carriers and/or used EMDEON to determine patient coverage and eligibility.
- Proficient in CRM system, Application Xtender, FACS Workstation for managing patient accounts.
- Maintained patient and customer contact to ensure accurate documentation and account information.
- Investigated claims that were denied and followed appeal process when applicable.
- Corrected all claims with errors such as incorrect I.D. numbers and insurance plans.
- Responsible for the posting of all claim payments.
- Processed hospital health insurance claims in coordination of benefits with patients auto and workers compensation insurance.
- Ensured that the client recovered the maximum allowable medical fees in the most timely, efficient and confidential manner.
- Participated and completed special projects upon request.
Education
The Career Institute of American International College
Braintree, MASkills
- Strategic Planning
- Resource Allocation
- Pipeline Administration
- Sales Support
- Forecasting
- Patient Advocate
- Employee / Vendor Relations Support
- Program Development
- Performance Management
- HIPPA Regulation
- Conflict Management
- Medical Ethics and Law
- ICD-9/ICD-10 coding
- CPT-4 Coding
- Administrative and Office Coordinator
- MS Word
- PowerPoint
- Excel
- Outlook
- NORI
- SalesForce
- Service Cloud
- EClinical Works
- Microsoft Suite
- Effective written and verbal communication
- Effective problem solving
Professional Development
- Performance Management
- HIPAA Regulation
- Conflict Management
- Medical Ethics and Law
- ICD-9/ICD-10 coding
- CPT-4 Coding
- Administrative and Office Coordinator
Timeline
Senior Patient Support Manager
Takeda Pharmaceuticals
02.2022 - Current
Patient Support Manager
Takeda Pharmaceuticals
01.2019 - 02.2022
Patient Support Manager
Shire Pharmaceuticals
06.2016 - 01.2019
Medical Biller/Adjuster BCBS
SMG Compass Medical Group
01.2009 - 06.2016
Medical Biller/Coder
Weymouth MRI
01.2009 - 12.2009
Medical Biller (contractor to permanent)
Claim Assist
01.2008 - 12.2009
The Career Institute of American International College