Lawrence Calvin Tolbert Jr
Memphis,TN
Summary
Proven Key Account & Field Reimbursement Manager with a track record of driving business growth through expert client relationship building, strategic account management, along with negotiating and developing new business within targeted and assigned accounts . Excelled in leveraging data-driven decision-making to exceed sales goals and educate physician offices on reimbursement initiatives demonstrating both strong analytical abilities and effective communication. Strong analytic, quantitative and technical aptitude with great attention to detail. Self-motivated, driven and adaptable with proven track record of exceeding goals.
Overview
19
19
years of professional experience
Work History
Key Account Manager/ Field Reimbursement Manager
Aimmune Therapeutics/ Nestle' Health Sciences
01.2020 - 10.2022
- Built and maintained strong client relationships to drive business growth.
- Strengthened client relationships through regular communication and effective problemsolving.
- Created sales forecasts to target daily, monthly and yearly objectives.
- Delivered exceptional customer service by resolving client concerns quickly and efficiently.
- Oversaw multiple accounts and worked diligently to meet and exceed performance sales goals.
- Conducted virtual and in-person presentations and inservices to large hospital institutions and private practices.
- Educate physician offices on entire reimbursement journey, including but not limited to prior authorizations, appeals/ denials, REMS and billing/ coding efforts.
- Coordinate with internal and external access matrix partners, including Palforzia Pathway HUB, Market access, and Account Manager sales teams to resolve barriers and assist prescription to fulfillment.
- Monitor national and local healthcare payor coverage policies to provide direct support and education to prescribing physicians and staff by identifying trends or barriers delaying therapy.
- Resolve concerns related to specialty pharmacy, REMS program, copay, and patient assistance programs.
- Execute payer engagement strategies to secure patient access and reimbursement for Palforzia.
- Create account plans to establish seamless and efficient processes increasing process education and maximum preparedness.
- Train all key stakeholders on FDA Risk Evaluation Mitigation Strategy (REMS) and standard operating procedures associated with therapy.
- Responsible for large multi-state territory, managing patient support services for several account sales managers.
- Host Speaker Programs and Lunch & Learn Events
- Leaders in Action Team
- Field Leadership Development Program
- Field Engagement Council
- Patient Services Advisory Panel
- Received 2021 Regional Key Account Manager of the Year Award
- Member of the Leadership Team for the DE&I group Kaleidoscope
Reimbursement Administrator
Benevere Specialty Pharmacy/ CVS Health
02.2014 - 11.2019
- Handled sensitive patient information discreetly, maintaining strict confidentiality at all times as required by company policy or legal regulations.
- Maintained personnel records and updated internal databases to support document management.
- Organized workflow and delegated tasks effectively to ensure timely project completion without compromising quality.
- Managed office inventory, ensuring adequate supplies were available for effective patient medication delivery.
- Provided exceptional customer service to both internal and external stakeholders through prompt response times and thorough issue resolution efforts.
- Supervised administrative support staff members, offering guidance, feedback, and mentorship that contributed to their professional growth and development.
- Successfully obtained prescription recruitment through cold calls and field sales.
- Educate physician offices on entire reimbursement process, including but not limited to prior authorizations, appeals/ denials, letters of medical necessity and patient benefit verification.
- Daily process electronic insurance claims for all patients, working rejections for various payors.
- Maintained accurate documentation for each patient for easy reference by all employees.
- Served as a liaison between departments, fostering open communication channels that improved overall organizational function.
- Coordinated company events and meetings to foster teamwork and boost employee morale.
- Facilitated communication between departments, ensuring smooth operation and timely completion of projects.
- Oversaw maintenance of office equipment, minimizing downtime due to malfunctions or repairs.
- Orchestrated effective office positioning, ensuring safe and compliant medication storage.
- Collected, arranged, and input information into database system.
- Educated staff on organizational mission and goals to help employees achieve success.
- Resolved escalated patient and physician issues through effective problem-solving resolutions.
Patient Account Representative
Accredo Health Group
07.2003 - 12.2013
- Assisted colleagues during peak periods or absences, showcasing teamwork skills while maintaining personal workload demands efficiently.
- Posted payments and processed refunds.
- Reviewed insurance eligibility and verified coverage details to minimize claim denials and delays in payment.
- Promoted a positive work environment by actively participating in team meetings and contributing ideas for process improvements.
- Worked with outside entities to resolve issues with billing, insurance claim rejections, and payments.
- Worked seasonally in the Intake Department resolving all issues for Synagis RSV patients including, but not limited to prior authorization and appeal/ denial management.
- Worked in the Reimbursement Department working claim rejections, investigating billing discrepancies, and implemented effective solutions to resolve future concerns.
- Streamlined billing processes for increased efficiency in managing patient accounts.
- Facilitated smooth communications between patients, providers, and insurers, fostering an atmosphere of trust and collaboration.
- Provided exceptional customer service, handling sensitive patient situations with professionalism and empathy.
- Conducted regular audits of patient accounts, identifying discrepancies and rectifying errors as needed.
- Ensured compliance with healthcare regulations while processing claims and managing patient accounts.
- Electronically submitted bills according to compliance guidelines.
- Collaborated with the medical staff to ensure proper documentation and coding for accurate billing.
- Enhanced patient satisfaction by promptly addressing inquiries and resolving account issues.
- Maintained accurate records of all transactions, ensuring timely payments from patients and insurance providers.
- Achieved a significant growth in prescription recruitment through cold calling and customer influence.
- Developed strong relationships with key contacts at insurance companies to expedite resolution of claim disputes or other account-related issues.
- Responded to patient, family and external payer inquiries.
- Utilized computer programs to create invoices, letters and other documents.
- Negotiated payment plans with patients experiencing financial difficulties, supporting them in meeting their obligations without undue stress.
- Reduced outstanding balances by implementing effective collection strategies tailored to individual patients'' needs.
- Educated patients on financial policies and copay assistance availability promoting understanding of their responsibilities within the healthcare system.
- Contacted patients after insurance was calculated to obtain payments.
- Reconciled statements with patient records.
- Responded to customer inquiries and provided detailed account information.
- Developed and documented collection procedures and policies to comply with government regulations.
- Monitored customer accounts for payment delinquency and initiated collection efforts.
- Performed Tennessee and federal regulations compliance audits related to documentation and reporting.
Education
Bachelor of Science - Business/ Sports Management
Arkansas State University
Jonesboro, AR12.2000
Skills
- Client Relationship Building through presentations and effective communication
- Business Development through sound territory research and successful field management
- Key Account Management by planning and managing relationships between company and customer
- Data-driven decision-making, then execution by meeting goals and quotas
- Specialty Pharmacy, Bio-pharmaceutical, and healthcare industries, including access & reimbursement, patient advocacy, account management, and sales
- Payer landscape to include buy and bill, medicare, medicaid, specialty pharmacy, and commercial coverage work streams
- Managed care and reimbursement resolutions, including REMS, as well has HUB access and protocols
- Customer engagement strategic plans for complex and multi-level account management
- Improved patient outcomes and access in a wide variety of disciplines, product formats, and delivery channels
- Cross functional internal and external partners engagement and creating working business plans to maximize results and efforts
Accomplishments
2021 Regional Key Account Manager of the Year Award
Timeline
Key Account Manager/ Field Reimbursement Manager
Aimmune Therapeutics/ Nestle' Health Sciences
01.2020 - 10.2022
Reimbursement Administrator
Benevere Specialty Pharmacy/ CVS Health
02.2014 - 11.2019
Patient Account Representative
Accredo Health Group
07.2003 - 12.2013
Bachelor of Science - Business/ Sports Management
Arkansas State University
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