Lakashia Turner

• Investigate patient's insurance coverage when applicable by conducting payer calls, utilizing insurance intel and web tools.
• Review financial documents for completion to assist with assessing for program eligibility.
• Provide subject matter expertise on medical and prescription insurance coverage, medication prior authorization process, and alternate financial assistance opportunities for patients.
• Apply AbbVie Patient Assistance Program standards to each case to render the appropriate decision of approval or denial into the program.
• Conduct the outreach process to obtain missing information that is required to complete an application assessment.
• Ensure all patient cases are documented in the Customer Relationship Management System (CRM) in accordance with all business rules and policies.
• Receive and handle incoming calls from patient's and HCPs.
• Complete renewal and year end recertification's process as determined by the AbbVie Patient Assistance Program.

• Maintained patient confidentiality by adhering to HIPAA guidelines.

• Maintained data entry requirements for all complaints, appeals and grievances
• Intake Provider Appeals and Reconsideration for payments, reimbursements, authorizations, denials of medical coverage and pre-determinations for eligible Medicare Advantage members
• Build 60+ case files daily for each complaint, appeal, and grievance, and ensures compliance with organizational and regulatory guidelines
• Researched CPT codes and denial codes to determine if providers or member appeal claims are true appeals or may need further review for a reconsideration to be upheld or overturned
• Maintained case assignment worklist assuring cases are on track and closed within the regulatory turnaround time
• Handled 50 inbound and outbound (mostly outbound) calls in a day using Avaya.

• Consulted with health care providers, case workers, medical, and staff administration, and accurately documents all communication with involved parties
• Verified members insurance benefits for eligibility of coverage via telephone, Emdeon, Availity
• And NaviNet Processed referrals for Home Health Care, Skilled Nursing Facilities, Durable Medical Equipment Provided copay calculations for the members copay for Home Infusion Therapy Relayed if the member will be denied or approved for coverage for services from Coram
• Assured all insurance information has been completely and accurately obtained
• Handled more than 50 outbound phone calls in a day using Avaya.

• Conducted outbound calls to patients to verify benefits
• Handled 40-50 inbound and outbound calls in a day
• Assured all insurance information has been completely and accurately obtained
• Notified appropriate work units of patient's insurance coverage authorizations or status
• Initiated Prior Authorizations through members insurance companies for physicians
• Verified patients' insurance coverage by contacting insurance companies or using online verification systems to ensure the accuracy of information such as policy status, coverage dates, and any limitations or requirements
• Confirmed patients' benefits, including co-pays, deductibles, and out-of-pocket maximums, to help patients understand their financial responsibilities for medical services
• Communicated with patients to explain their insurance coverage and benefits, including any potential out-of-pocket costs
• Worked closely with healthcare providers to ensure that insurance information was accurate and up-to-date, helping to streamline the billing process and avoid claim denials
• Maintained accurate records of insurance verification and benefit information, ensuring that information was easily accessible for billing and administrative purposes.

• Received and responded to member telephone inquiries regarding eligibility, benefits, and authorization services
• Verified member coverages and benefit types, claim payment and status for providers
• Estimated members out of pocket expenses for select procedures or services
• HIPAA adherence.