
Accomplished Sr. Reimbursement Specialist with a proven track record at United Biosource Corporation, excelling in HIPAA Compliance and Denial Resolution. Demonstrated expertise in healthcare reimbursement and insurance verification, enhancing operational efficiency and patient care. Skilled in fostering professional relationships and adept at navigating complex insurance landscapes.
Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient.
Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies. May serve as single point of contact for an assigned group of prescribers.
Identify and report events as required by the REMS requirements for specified medication. Recognize adverse event, product quality complaint, potential risk events, and forward information to the appropriate team member for reporting to the manufacturer.
Educate patients, prescribers, and others regarding program requirements, and facilitate referrals. Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.
pharmacy representative. CCA also handle Data entry.
Pharmacy representative- CCA will take inbound calls and guide the pharmacy representative to
online portal to help them with a PDA for the patient. We can help them to log into Their account
"pharmacy portal" by sending a link and guide them with the steps that is needed. We will also
taking an adverse event over the phone if needed. We can also help them with PDA over the
phone and complete testing and counseling for them as well.
Prescriber- CCA will help prescriber and staff for enrollment, online portal access, adverse
events for the patients, enrollment for prescriber, staff and patients. We will help them with refill
dispense exception.
Patient- CCA will help patient with monthly patient testing and counseling. We will help them
with treatment interruptions, adverse events, updating their information such as addressing
phone number etc.
Data Entry- CCA handle Data entry for patient, prescriber and pharmacy representative. CCA
responsibility for data entry was enrollment for patient, prescriber and pharmacy. Completing
adverse events and patient monthly testing and counseling.
CCA also handle treatment interruption and yearly updates for reproductive potential.
• Review incoming referrals for completeness of and confirm FDA requirements are met as
applicable. These are typically received via facsimile, Web portal or client partner
download.
• Answer all Incoming calls quickly and efficiently, evaluate their need and respond or
disseminate call to appropriate member of team.
• Provide assistance with reimbursement inquiry requests, including insurance benefit
verification, prior authorization, denials and appeals, and other reimbursement issues
from patients, MDOs, payers and Sales Representative
• May provide billing and coding information related to specific product(s)
• Conduct general payer research
• Investigation of benefits and eligibility by phone and/or internet to determine coverage
choices patient has in starting therapy.
Client Central- I used that system for filing disputes, opening and closing accounts, changing
clients personal information such as name, address and phone number. We also searched the
clients account for transactions, to transfer money from a savings or checking a account.
We can open multiple accounts for IRA'S, Trust and CD's.
For PBM we use that for filing disputes and also sending out debit cards as well.
Utilized Pay my loan to make payments on car or house loans.
Responsible for maintaining a high level of professionalism with all interactions while working to
establish a positive rapport with every caller.
Reference
Crystal Vonhatten- 217-419-1649
LaTonya Smith- 901-355-5989
Tiaes White- 337-303-5479
Mary Adkins- 304-751-5107