Kalisha Barksdale

• Handle and manage assigned APA (Appeal Program Administration) cases received daily, ensuring prompt and thorough attention to each case
• Assist in special projects or cases assigned by the Director, PM (Program Manager), or APMs (Appeal Program Managers), demonstrating flexibility in handling diverse tasks
• Establish and maintain strong relationships, trust, and rapport with patients, healthcare providers, and client contacts, serving as a liaison for sales representatives when needed
• Apply critical thinking skills to efficiently and accurately resolve the intricacies associated with APA cases
• Perform thorough insurance benefit investigations, communicate coverage details to patients and providers, guide and follow up on prior authorizations, and assist with the appeal processes as required

* Auditing cases start to finish to ensure processes are flowing correctly. Identifying trends and the trends led to implementing new/updated processes.

* Running reports daily and exporting to excel live spreadsheet.

* Monitoring AIs monitoring BI Cases to ensure cases are going through Infinitus correctly.

Identifying gaps in processes and reporting.

• Provide inbound and outbound phone support for payers, patients, caregivers, specialty pharmacies, site of care centers, specialty distributors, pharmacy compounders, and providers
• Maintained records in accordance with applicable standards and regulations to the programs/promotions
• Followed program guidelines and escalates complex cases according to SOPs, Call Guides, and other program materials
• Provided unparalleled customer service, with attention to detail, while serving as a brand advocate and program representative; understands the importance of achieving quality outcomes and commit to the appropriate use of resources
• Knowledge and understanding of the different types of major payers including private/commercial and government (Medicare, Medicaid, VA, DoD)

• Serve as an expert on reimbursement issues and be responsible for handling the day-to-day activities within reimbursement services (benefits investigation, prior authorizations, and appeals support)
• Complete medical and/or pharmacy benefit investigations, identify and facilitate submission of required documentation for payer/plan review for prior authorization, step edit identification and appeals according to program standard operating procedures
• Knowledge and understanding of the different types of major payers including private/commercial and government (Medicare, Medicaid, VA, DoD)

• Present subject matter to students under the direction and guidance of teachers, using lectures, discussions, or supervised role-playing methods
• Discuss assigned duties with classroom teachers to coordinate instructional efforts
• Enforce administration policies and rules governing students
• Grade homework and tests, and compute and record results, using answer sheets or electronic marking devices
• Instruct and monitor students in the use and care of equipment and materials, to prevent injuries and damage

• Greet and assist incoming patients with triage paperwork
• Utilize computer software program to transcribe patient information and update accordingly
• Notify physician and nurse of arriving patients
• Answer and direct incoming calls and respond to questions pertaining to insurance inquiries and billing discrepancies
• Receive payments for services, print receipts, and enter financial transactions
• Arrange payment for services and discuss different financing options
• Discuss benefits and eligibility with the patient insurance to determine coverage and accumulations with vast insurance companies
• Assist with initiating prior authorization request on behalf of the provider with knowledge in CoverMyMeds