Heather Taylor
Irwin,USA
Summary
Reimbursement expert with over 24 years of combined experience in field reimbursement and account management, patient access services, Prior Authorization and Appeals specialist, Medicare Specialist, Veterans Affairs and DoD Subject Matter Expert, program portal administration, pharmacy technician, supervisor, trainer, and mentor.
Overview
24
24
years of professional experience
Work History
Access and Reimbursement Manager
CoverMyMeds
Access and Reimbursement Manager
Teva Pharmaceuticals
04.2025 - Current
Access and Reimbursement Manager
Bristol Myers Squibb
11.2021 - 04.2025
- Expert breaking down payer roadblocks, appealing adverse determinations, and finding alternate patient assistance through foundations. Northeast and Mid-Atlantic Regional payer expert. Communicate and collaborate cross-functionally with Matrix partners to get patients started and maintained on therapy. Educate office personnel on prior authorization, appeals processes, and patient support programs. Plan and conduct field visits to HCP offices to facilitate pull through efforts and problem solve escalated issues. Establish and maintain knowledge on the local and national payer landscape, including Specialty Pharmacy and Utilization Management. Create and continually grow strong working relationships with all internal and external customers. Mentored and supported multiple new employees, covered multiple geographies, created and presented several trainings: Journey of an RX, VA and DoD Payers, Policy Reporter, Veeva/Sales Force, and Day in the Life of a Patient with oHCM. Extensive experience with REMS Programs, Medical and Pharmacy Benefits. DoD/Tricare/VA Subject Matter Expert; Mentor; FY23 Field Reimbursement Manager of the Year.
Dupixent MyWay Coordinator, Appeals Reimbursement Specialist, Provider Portal Administrator
Lash Group
02.2019 - 11.2021
- Provide advanced reimbursement and market access services and education to providers. Daily tasks include but not limited to: reimbursement support, prior authorization assistance, educating Biologics Coordinators and HCP on payer issues, assessing and educating office staff for Patient Assistance Programs. Researching and resolving roadblocks including denials, appeals, or specialty pharmacy issues. Established as regional expert on payer trends and reporting any reimbursement trends / delays (such as: billing denials, claim denials, pricing errors, payments, etc.). Collaborate and strategize with multiple field teams including FRMs and ABMs. Hold weekly Matrix Calls to discuss cases with Area Business Managers and Field Reimbursement Managers. Hold weekly “Virtual Lunch” meetings with Providers and Field Team to educate and communicate reimbursement issues, therapy delays, Cover My Meds, and market access programs. Daily follow ups with Specialty Pharmacies to track the patient's order status to get the patient on therapy faster. Provider Portal Administrator, assisting providers in registering for the Dupixent MyWay Provider Portal, and educate the office staff about the portal and all that it offers. Have been part of the Adverse Event tracking Sub Team as well. Provider Portal, Patient Access Specialist and Appeals Team trainer. Coordinator covering Bethesda and Baltimore, Maryland, Washington DC, Arlington, VA and Charlestown, WVa. Lead Patient Access Specialist mentoring all new Patient Access Specialists and Dupixent MyWay Nurses. A member of the Employee Engagement Committee. TJ Award Winner for June my work with the region’s sales teams (Sanofi and Regeneron) and biologics coordinators.
Transplant and Cystic Fibrosis Team
CVS Caremark Specialty Pharmacy
09.2017 - 05.2018
- Reimbursement expert working with Medicare, Medicaid, Commercial and other government payers (Tricare, VA) and workers compensation payers. Worked specifically with Medicare claims on the transplant, HIV, and Cystic Fibrosis teams working with the most complicated insurance processes. Contacted patient's insurance companies and Medicare to discuss formularies and coverage on all claims. Utilized CPT and ICD-10 coding. Coordinated with transplant teams, nurses, specialists and medical staff. Educated specialists on preferred treatments, per payer. Contacted patients to explain coverage. Worked on daily check-lists to effectively processes as many patients as possible, due to high influx of patients as the company rapidly expanded. Processed prior authorizations and followed-up with both PCP’s and patients to explain approvals and denials, as well as the process. Medicare Specialist on the Transplant Team first then on Cystic Fibrosis. I have an extensive knowledge of Buy and Bill, Government sponsored payers, such as Medicare, Medicaid, and DoD, as well as Commercial Medical and Pharmacy payers and regional payer trends.
Inpatient/Operating Room Pharmacy Technician
UPMC Presbyterian/Montefiore/Children’s Hospital
05.2014 - 09.2017
- Worked alongside CRNA’s, Anesthesiologists, Surgeons, and Pharmacists within the operating room Pharmacy and inside the actual OR suites during surgeries to provide the appropriate medications for the patients during surgeries. Within the pharmacy, I compounded medications as needed, performed daily inventory audits, organized pharmacy paper work and created daily orders to keep the appropriate medications available to the surgical services team. Monthly competency reviews with technicians and surgical services. Delegate work during busy and short-staffed days to meet hourly and daily production goals. Daily billing of medications used to patient charts, and ensuring all HIPAA and JACHO guidelines are thoroughly carried out by all staff.
Patient Care Advocate/ Medicare Specialist
CVS Caremark Specialty Pharmacy
09.2014 - 01.2016
- As a Patient Care Advocate, I worked with all specialty patients to resolve any issues that came up during their treatment. I also was put on special assignments regularly, such as Women's Health division, treating infertility, and our Synagis team to expedite and resolve insurance issues for babies with RSV, so that treatment could begin as soon as possible. The role as a Patient Care Advocate also included supervisory roles, fielding and distributing escalations, call monitoring, training employees, mentoring new associates, contacting medical professionals and learning the ins and outs of specialty medications and advanced disease-states.
Lead Pharmacy Technician
Eckerd/Rite Aid Pharmacy
08.2001 - 12.2013
- Senior Lead Technician in charge of supervising, training, and assisting all pharmacy associates. Properly filled and dispensed an average of 350 prescriptions per day. Processed insurance claims, followed up on rejected claims, prior authorizations, and worker’s compensation claims, both ECS and paper claims. Processed and dispensed prescriptions. Spoke with customers and answered questions. Took monthly inventory, and daily safety checks. Trained all incoming pharmacy associates and interns.
Integration Specialist
Eckerd/Rite Aid Pharmacy
01.2008 - 06.2008
- Specially trained to assist with the six-month transition of the Eckerd pharmacies in the Pittsburgh area following the Rite Aid acquisition. Trained pharmacy employees on the new policies and procedures, and computer systems. On-hand at stores on live dates to make a smoother transition.
Education
BA - History - Specializing in Research
Seton Hill University
Greensburg, PA12.2013
High School - undefined
Norwin Senior High School
North Huntingdon, PA06.1999
Skills
- Denial resolution
- HCPCS coding
- HIPAA compliance
- Written and verbal communication
- Insurance verification
- Issue resolution
- Managed care
- Medicaid expertise
- Provider relations
- Utilization review
- Reimbursement strategies
- Medicare
- Reimbursement management
- Analytics skills
- Teamwork
Timeline
Access and Reimbursement Manager
Teva Pharmaceuticals
04.2025 - Current
Access and Reimbursement Manager
Bristol Myers Squibb
11.2021 - 04.2025
Dupixent MyWay Coordinator, Appeals Reimbursement Specialist, Provider Portal Administrator
Lash Group
02.2019 - 11.2021
Transplant and Cystic Fibrosis Team
CVS Caremark Specialty Pharmacy
09.2017 - 05.2018
Patient Care Advocate/ Medicare Specialist
CVS Caremark Specialty Pharmacy
09.2014 - 01.2016
Inpatient/Operating Room Pharmacy Technician
UPMC Presbyterian/Montefiore/Children’s Hospital
05.2014 - 09.2017
Integration Specialist
Eckerd/Rite Aid Pharmacy
01.2008 - 06.2008
Lead Pharmacy Technician
Eckerd/Rite Aid Pharmacy
08.2001 - 12.2013
Access and Reimbursement Manager
CoverMyMeds
High School - undefined
Norwin Senior High School
BA - History - Specializing in Research
Seton Hill University
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