Jaclyn Pitteroff
Pittsburgh,PA
Summary
Dynamic insurance professional with extensive expertise in reimbursement processes and claims management, recognized for fostering collaboration and driving results in fast-paced environments. Demonstrated ability to interpret complex policies and build strong client relationships, consistently delivering reliable and flexible solutions. Committed to enhancing operational efficiency while navigating the intricacies of the insurance landscape. A proactive approach to problem-solving ensures alignment with organizational goals and client satisfaction.
Overview
16
16
years of professional experience
Work History
Reimbursement Specialist
RAREMED PSC TO JOHNSON AND JOHNSON PATIENT SERVICE CENTER
04.2024 - 04.2025
- Serves as the reimbursement expert for medical and pharmacy billing on a dedicated program team.
- Coordinates investigations and determination of patient benefits with internal program operations, insurance plans, and specialty pharmacy liaisons.
- Applies business rules to qualify patients for manufacturer supported programs.
- Works independently to complete assigned work in accordance with Standard Operating Procedures and defined service levels to complete benefits verification process, prescription coverage, and answer inquiries.
- Uses high-level problem-solving skills to research cases and resolve independently using creativity, innovation, and professional judgement to make sound decisions.
- Maintains frequent phone contact with payers to gather all necessary information related to case/patient information, insurance coverage, and where applicable, prior authorization (PA) or appeals tracking and follow up.
- Independently and effectively verify coverage and proactively enroll eligible patients into the commercial copay program.
- Efficiently process patient and prescriber requests to accelerate access to therapy.
- Coordinate and collaborate with internal team members to provide reimbursement information to manufacturer representatives, Health Care Prover offices and other key personnel.
- Participating in continued education on product changes, new features, and product launches
- Strong compliance mindset, demonstrating clear understanding of patient privacy laws.
- Active participation in building and maintaining respectful, collaborative internal/external team relationships, exercising, and encouraging positivity.
- Interpreted AI results from medical and pharmacy payers through Infinitus program and assisted with Benefit Verification
Patient Support Specialist
BLINK HEALTH LLC/BLINK RX
07.2023 - 01.2024
- Receiving inbound phone calls to resolve routine and new issues with patients, providers, and insurers
- Utilizing Google docs, Slack platform for internal communications and customer resolutions
- Conducting outbound calls to patients regarding current prescriptions and offering financial assistance if needed
- Providing direct patient care to accurately support pharma programs and triage to appropriate teams when required
- Striving to meet and exceed structured performance targets.
- Documentation on all calls with accurate information and data discovery according to operating procedures
- Utilizing the Knowledge Base materials as a foundation for resolving inquiries
- Maintaining confidentiality of patient and proprietary information
- Developing a working knowledge of company related security and privacy practices.
- Participating in continued education on product changes, new features, and product launches
- Helping to improve the patient experience by sharing feedback with management to further develop the products, materials, and internal processes
Life Claims Representative
NEW YORK LIFE INSURANCE COMPANY
05.2022 - 04.2023
- Responsible for client service and administration of group annuity contracts that fund pension plan obligations from the pension risk transfer business.
- Reviewed and interpreted contract language relative to calculating and processing retirement benefits
- Processed benefit payments to retirees in our annuity payment systems
- Reviewed and interpreted contract languages and retirement certificates relative to death benefits payable as a result of an annuitant's death
- Reviewed retiree's forms and other supporting documentation for completeness and accuracy
- Located participants that may have due and unpaid benefits
- Handled inbound phone inquiries from retirees and/or their family member(s), financial institutions, and contract holders.
- Processed routine financial and non-financial activity on client accounts with both expediency and accuracy
- Assisted with projects as needed
- Handled inbound and outbound calls to customers
- Data intake with claims and health codes
- Life insurance terminology and interpretation
Patient Services Representative
LASH GROUP AMERISOURCEBERGEN CORPORATION | BMSPAF – BRISTOL-MEYERS SQUIBB PATIENT ASSISTANCE FOUNDATION
08.2018 - 07.2021
- Answered basic clinical and program inquiries for the BMSPAF Foundation for the medication Eliquis
- Coordinated access to therapies, schedules and conduct appropriate follow-up, and facilitate access to appropriate support services.
- Assisted processing with incoming enrollment forms for the foundation
- Program follow up via phone, mail, and/or fax for missing enrollment information with patients and providers
- Supported payer research, health care policies and federal compliance protocols
- Researched and identified other sources of health care coverage and financial assistance for patients
- Assisted with treating provider NPI and State License verifications
- Assisted with inbound calls to the foundation along with outbound call correspondence and follow up
Reimbursement Counselor
LASH GROUP AMERISOURCEBERGEN CORPORATION | JANSSEN BIOTECH INC
09.2010 - 08.2018
- Collected and review all patient insurance benefit information, to the degree authorized by the SOP of the program.
- Provided assistance to physician office staff and patients to complete and submit all necessary insurance forms and applications.
- Completed and submit all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third-party payors.
- Effectively utilized various means for collections, including but not limited to phone, fax, mail, and online methods.
- Provided exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
- Coordinated with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
- Maintained confidentiality regarding patient account status and the financial affairs of clinic/corporation.
Simponi One Care Coordinator Program Representative
CVS CAREMARK LASH GROUP AMERISOURCEBERGEN CORPORATION
09.2009 - 09.2010
- Answered basic clinical and program inquiries regarding SimponiOne
- Coordinated access to therapies, schedules and conduct appropriate follow-up, and facilitate access to appropriate support services.
- Processed incoming enrollment forms for programs
- Follow up via phone, mail, and/or fax for missing enrollment information with patients
- Supported payer research, health care policy library, and state management.
- Assisted with customer financial support programs
- Identified other sources of health care coverage for patients through queries and other sources.
- Prior authorization assistance and follow up
- Specialty pharmacy follow up and triage assistance
- Explaining benefits and insurance coverage to patients and providers
- Contacting insurance payers to obtain benefits
- Assisted Data Intake with enrollment forms involving multiple specialty medications
Education
Bachelor of Science - Elementary Education
Duquesne University
Pittsburgh, PASkills
- Adept at using Microsoft Office applications
- Skilled in managing specialty medication insurance claims
- Relationship management proficiency
- Conflict resolution
- Effective communication
- In-depth knowledge of healthcare insurance options
- Extensive background in customer service
- Analytical problem-solving
- Experienced in using Word and Excel for various tasks
- Proficient in organization and task management
- Effective communication in diverse formats
- Experienced in customer support
- Self-directed with team alignment
- Adherence to established procedures
Timeline
Reimbursement Specialist
RAREMED PSC TO JOHNSON AND JOHNSON PATIENT SERVICE CENTER
04.2024 - 04.2025
Patient Support Specialist
BLINK HEALTH LLC/BLINK RX
07.2023 - 01.2024
Life Claims Representative
NEW YORK LIFE INSURANCE COMPANY
05.2022 - 04.2023
Patient Services Representative
LASH GROUP AMERISOURCEBERGEN CORPORATION | BMSPAF – BRISTOL-MEYERS SQUIBB PATIENT ASSISTANCE FOUNDATION
08.2018 - 07.2021
Reimbursement Counselor
LASH GROUP AMERISOURCEBERGEN CORPORATION | JANSSEN BIOTECH INC
09.2010 - 08.2018
Simponi One Care Coordinator Program Representative
CVS CAREMARK LASH GROUP AMERISOURCEBERGEN CORPORATION
09.2009 - 09.2010
Bachelor of Science - Elementary Education
Duquesne University