Krystle Stinson

Specific Responsibilities Include:

· Proactively own and manage robust case load effectively to meet internal stakeholder and external partner deadlines

· Frequent inbound and outbound communication (via phone, email) with claimants and medical facilities to expedite and ensure accurate and timely case progression

· Initiate and monitor the medical record retrieval process by tracking the progress of open requests, resolving issues, and processing documents to prepare for medical record review

· Ensure case documentation is standardized and following appropriate protocols for each campaign

· Continually evaluate established processes and procedures and offer suggestions for change and/or improvement including medical record forms

· Assist Operations Manager with case load audits and reporting for existing and new campaigns

· Negotiate terms of invoices received from medical record facilities, process as appropriate or escalate for approval and payment if needed

· Partner with relevant internal teams to provide timely updates and feedback to law firm clients

· Ensure case documentation is standardized and following appropriate protocols for each campaign

Experience/Skills:

• Working knowledge of electronic health records (EHR) and HITECH and will be able to suggest and implement efficiencies and improvements while keeping updated on industry best practices a plus

• Owns strategy for medical record retrieval using cutting edge technology and efficient processes

• Utilize reporting, metrics, and KPI’s to track and develop process changes.

• Highly self-motivated with the ability to multi-task and prioritize a large caseload

• High level of empathy, compassion and patience to help guide claimants through difficult conversations and unfamiliar processes

• Ability to work on complex projects utilizing sound judgement and decision making skills with minimal guidance

• Excellent interpersonal, customer service, verbal and written communication, and problem-solving skills

• Knowledge of law firm, healthcare, and corporate operations workflow processes preferred

• Prior experience with mass tort, patient medical records, including medical device and pharmaceutical terminology is preferred

• Maintain a confidential, HIPAA compliant environment

• Proficiency with Microsoft office tools

• Ability to work independently and in a team environment

• Obtain requests from provider or pharmacy via fax
• Use multiple software systems and various resource sites to determine member plans and requirements and triage for casebuild
• Conducts all necessary research such as verifying benefit coverage for the patient, and then creates the case (data entry) in Highmark’s utilization management system for clinical review
• Contact by phone members, providers and/or pharmacists to provide results of authorization requests
• Hold collaborative discussions with physicians or medical staff, when needed, to obtain additional documentation in the record to support medical necessity, discharge needs, or fulfill other payer requirements
• Ensures all accurate information is entered at the onset of the process to ensure adherence to all regulatory compliance requirements and service level agreements
• Documents every outreach call with appropriate actions and notes to support contracted and compliance requirements and clarity about each interaction or attempt to interact
• Gather all required documentation including verification of benefit eligibility
• Use knowledge of process and judgement to evaluate identified cases that require additional notification to member, provider, and/or pharmacist
• Remote

• Deliver support to identified patients, caregivers, healthcare professionals and their staff within primary care or specialist facilities related to Biogen neurology products in the form of prior authorizations, enrollment form validation, reimbursement education and support, and relationship management
• Receive and review new support services request forms for missing information (ie: insurance information, dates, signatures)
• Maintain internal processing database to document work activity and communication on all assigned cases
• Develop strong working relationships with physician office staff, providing additional office support to ensure smooth maintenance of patients enrolled in the program as needed
• Overseeing the patient lifecycle from referral to therapeutic graduation which includes: referral routing support, therapy education, insurance research and education, financial assistance support, and nursing coordination
• Facilitate communication with field base employees to provide real time updates and connect on the status of cases
• Report Adverse Events and Product Complaints following program Standard Operating Procedures
• Identify obstacles to obtaining coverage and channel information to internal work groups
• Informally mentoring case managers and service coordinators, answering questions, offering opportunities to shadow and observe and explaining basic information about company procedures

• Managed a book of business with over100 long term care pharmacy accounts
• Account manager for all new clients post implementation
• Create and develop long-term client relationships of trust with new and existing clients through a deep understanding of the long-term care industry, back-up pharmacy services and an overall business and market viewpoint
• Respond to client inquiries for information and service requests acting as the liaison between the client and other business units
• Support the sales team with pre-sales and marketing efforts through outbound prospecting campaigns and conducting demos for prospects
• Identify and develop upsell opportunities by studying current business; building relationships with key client stakeholders; identifying and evaluating additional needs
• Oversee account implementation and client on boarding for all new clients and current book of business on new platform
• Provide timely resolution and solutions to client complaints, problems, or service concerns
• Develop and conduct client in-service trainings for new products and services
• Support clients by answering application questions, monitoring and documenting issues and trends, and escalating when necessary
• Provide timely and reliable client reports as requested; identify areas in trend reports for additional opportunities
• Negotiate contractual arrangements after program go-live
• Create and maintain client accounts and new prospects via Salesforce and contribute to the database on a daily basis
• Assist the finance department on accounting aspects of assigned clients/accounts
• Present quarterly business reviews to key stakeholders
• Set up appointments with potential and current customers to discuss new products and services
• Perform other assignments for Director and President

• Answers employee and HR questions regarding benefits, including but not limited to retirement (401(k)), health, prescription, dental and vision insurance, life and accidental death and dismemberment insurance, ACA, COBRA, ERISA, etc
• Enroll active employees and retirees into benefits during open or special enrollments
• Assist with creating benefits guides during implementation of new clients
• Serve as peer guide for new associates, demonstrating a commitment to providing industry leading customer service
• Facilitated Open Enrollment trainings across sites
• Complete call evaluations for associates to ensure accurate information is provided to employees, dependents, and retirees
• Communicate specific plan offerings, coverage options, cost comparisons and other information as it pertains to the plan
• Assist future retirees with the initiation of pension benefits
• Consult with payroll to research and resolve billing issues
• Met or exceeded service and quality standards every review period
• Accurately document, research and resolve customer service issues and schedule follow-up calls if needed
• Improve call center functionality and service capacity by resolving participant complaints efficiently and quickly
• Interact with carriers to resolve claims issues
• Direct and assist participant queries to the appropriate party regarding claim submission, status, payment or dispute and site-specific coverage information
• Diffuse volatile customer situations calmly and courteously
• Mastery of customer service management systems and databases
• Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately
• Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions

• Investigate root causes of customer issues by reviewing and scoring calls
• Identify trending and escalate situations that pose risk to Fidelity and/or the customer
• Thoroughly document and effectively resolve escalated concerns
• Identify and process resource updates to close knowledge gap
• Provide feedback to managers and associates regarding quality findings
• Manage case load and meet service level agreement expectations
• Partnered with internal business units to resolve sensitive cases