Hope Henderson
Fort Worth,TX
Summary
Dynamic Case Manager with TEKsystems, skilled in benefit verification and reimbursement processing. Proven ability to analyze data and advocate for patients, enhancing their experience. Adept at conflict resolution and delivering exceptional customer service, ensuring seamless interactions with healthcare professionals and patients alike. Committed to continuous improvement in healthcare operations.
Overview
11
11
years of professional experience
Work History
Case Manager
TEKsystems
10.2024 - Current
- Verify benefits for each patient, and assist with copay, prior authorizations, and reimbursement issues.
- Maintain positive rapport
- Handle inbound and outbound calls from HCPs and patients, and enter all appropriate data into the system.
- Compile and analyze data regarding reimbursement trends to assist with continuous improvement efforts.
- Work with both commercial and government payers
- Interact with pharmacies to expedite a positive patient experience.
Service Representative
TEKsystems
06.2023 - 10.2024
- Take inbound communications and outreach from healthcare professionals to assist with benefit verification requests
- Make outbound communications with health plan professionals to obtain any missing demographics or health plan documentation needed for requested services
- Identify if there are any additional actions needed to complete benefit verification request
- Performing clerical tasks to evaluate insurance cases, investigate cases, and update the account information of the clients on the database
- Currently working on special projects for Medicare Special Queue and Bone Matters
Benefit Verification Specialist
TEKsystems
04.2022 - 06.2023
- Verifying benefits for each assigned patient case and detailing any requirements for reimbursement, including copays, coinsurance, utilization management requirements, qualifications/restrictions, and prior authorization requirements.
- Taking calls and outreach from healthcare professionals, and entering data into supporting systems to initiate enrollment of new or existing patients.
- Initiating benefits verification by reviewing patient data and insurance material, including identifying missing information, and following up with points of contact to resolve information gaps.
- LMS trainings: Maximizing Amgen's Performance, Career Development, Preparing For Your Internal Interview
Medical Office Specialist II
Texas Neurology
05.2019 - 01.2022
- Interact with patients on the phone and/or face to face to support the front office operations
- Deliver superior customer service, represent Texas Neurology in a positive and professional manner to patients, colleagues, and the community
- Maintain neatness of customer waiting area; keep area stocked with pamphlets
- Ensure adequate inventory of items necessary for day-to-day functions of clinic, such as office supplies and patient forms
- Regularly Maintain, modify, release patient records
- Verify Insurance and educate patients on their insurance policies
- Assist patients with registration and scheduling
- Answer telephone calls from patients
- Obtain copays from patients
- Transmit all electronic claims to the billing vendor and work rebills submitted to the billing department
- Mail out billing statements to patients regarding their unpaid balances
- Pull charts for following day appointments and create new patient charts
- Accurately take messages for physicians and nurses and deliver in a timely manner
Front Desk Receptionist
Seton Family of Doctors Plus Express Care
11.2016 - 04.2019
- Check patients in/out
- Insurance Verification
- Take payments
- Handle Referrals
- Handle Medical Records and Billing
- File charts
Patient Care Specialist II
Amber Pharmacy
06.2015 - 11.2016
- Explain all company programs/services to patients and provider's office
- Contact patients to schedule new medication deliveries, confirm address, inform of copayment responsibilities, obtain basic medical background information
- Monthly calls to patients for: monitor adherence/persistence of medications, evaluate adverse reactions, and refer patients to clinical pharmacist/nurse as needed
- Responsible for entry of pertinent information in system for all new referrals
- Communicates to patients for prescription refills and refers any medication or illness-related questions/concerns
- Record and process orders received by mail, phone or through direct patient contact
- Maintain documentation of calls to/from patients, caregivers, insurances, providers and Pharma
- Create patient reminders for follow-up calls, clinical assessments, referrals to Case Management, initiation of discharge, patient-letter mailings or reminders for patient care
- Contact referring nurses/coordinators according to assigned team regarding insurance verification findings and patient issues
Patient Care Advocate II
Express Scripts
01.2014 - 06.2015
- Handle inbound clients calls and written correspondence and questions via the web while maintaining service levels
- Make independent judgments in order to respond to complex or critical customer issues
- Take overflow calls from members, physicians and providers
- Work with other operational departments to research and resolve mail order claims issues, respond to members, clients and account managers within performance agreement guidelines
- Maintain accurate and complete documentation of all inquiries
- Identify, document and report all repetitive questions and/or problems and recommend potential solutions
- Assist with work distribution, expedition, and the development of work plans for reps
- Provide on-the-job training for new or existing reps
- Work collaboratively with other Customer Service Advocates/Customer Service Representatives to ensure that best-practices are shared
Education
Associate - Business Management
Florissant Valley Community College
St. Louis, MOSkills
- Benefit verification
- Reimbursement processing
- Data analysis
- Insurance knowledge
- Patient advocacy
- Customer service
- Conflict resolution
- Call handling
Organizations And Community Service
Black Wolf (College based), Organization where we collect outside resources to help young inspiring business owners.
License - Type
Pharmacy Technician
Timeline
Case Manager
TEKsystems
10.2024 - Current
Service Representative
TEKsystems
06.2023 - 10.2024
Benefit Verification Specialist
TEKsystems
04.2022 - 06.2023
Medical Office Specialist II
Texas Neurology
05.2019 - 01.2022
Front Desk Receptionist
Seton Family of Doctors Plus Express Care
11.2016 - 04.2019
Patient Care Specialist II
Amber Pharmacy
06.2015 - 11.2016
Patient Care Advocate II
Express Scripts
01.2014 - 06.2015
Associate - Business Management
Florissant Valley Community College
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