Key-Sha L. Rene'

I am a Reimbursement Specialist who ensures healthcare providers and organizations receive appropriate payment for services rendered. I handle tasks like verifying insurance coverage, submitting claims, and communicating with insurance companies, and patients. I am also required to stay updated on insurance policies and regulations that affect reimbursements. While also initiating prior authorizations and appeals.

• Launched Gilead and Asegua support path program.
• Received incoming phone calls and contact form submissions and provided timely responses to inquiries.
• Collaborated with other program coordinators to achieve consistency in program objectives and services.
• Kept program-related data accurate, up-to-date and easily accessible for accessibility.
• Provided ongoing direction and leadership for program operations.
• Created and delivered program training and education to keep participants
• Knowledgeable about program and provide necessary skills to participate productively.
• Outbound calls to healthcare providers to obtain prior authorizations, prescriptions, intake forms
• Inbound calls from patients wanting applications status.
• Outbound calls to insurance companies to verify pharmacy benefits, complete benefits investigation.

• Conducted interviews with patients and family members and answered questions regarding insurance benefits.
• Identified healthcare resources and programs for patients unable to meet financial obligations.
• Liaised between patient, doctor and insurance provider to smooth claims processes.
• Documented details regarding contact with patients, providers and other individuals in system.
• Contacted insurance providers to obtain key information regarding patient benefits and to submit documentation for accounts.

• Responsible for responding to and researching and resolving escalated high dollar inquiries and complaints.
• Review in-process, closed or cancelled single loan, credit exceptions, applications, claims, online transactions.
• Effectively communicate with customers, clients, merchants, agencies, bankers, executive and regulatory/ governmental representatives.
• Perform intake to determine appropriate actions, conducting investigate steps to identify the issues, researching terms, conditions and contracts.
• Handle client escalated issues and provide follow up to the account team until resolved.
• Effectively collaborate with other departments to resolve issues.
• Work along with specialty pharmacies to resolve member issues.

• Resolved complex client escalations, ensuring timely and effective solutions to enhance customer satisfaction.
• Collaborated with cross-functional teams to streamline processes, improving response times for escalated issues.
• Analyzed root causes of escalations, developing strategic recommendations for process improvements.
• Mentored junior specialists in escalation handling techniques, fostering a culture of continuous learning and development.