Summary
Overview
Work History
Education
Skills
References
Affiliations
Languages
Timeline
Generic

Leslie Wiggins

Apopka

Summary

Management professional with over 10 years of experience in leadership and patient services. Proven track record in supervising eligibility operations, enhancing team performance, and delivering exceptional customer service. Expertise in eligibility criteria and public assistance programs, coupled with strong skills in staff training and development. Recognized for high productivity and effective communication, ensuring seamless eligibility processes.

Overview

16
16
years of professional experience

Work History

Eligibility Supervisor/ Reconsideration Supervisor /Complaints Supervisor

Tidal Basin Consulting
07.2021 - Current
  • Managed eligibility specialists, coordinators, and subject matter experts to support program activities.
  • Oversaw program management organization to ensure accountability and adherence to policies.
  • Reviewed appeals from applicants as Reconsideration Lead, ensuring compliance with program guidelines.
  • Resolved program service and procedure issues efficiently to enhance operational effectiveness.
  • Established performance objectives and provided continuous feedback for team improvement.
  • Authored formal internal and external reports that maintained clarity and conciseness.
  • Demonstrated strong work ethic while adhering to professional ethics and boundaries in care.
  • Maintained comprehensive knowledge of all relevant program policies and requirements.
  • Recommended solutions related to staffing issues and proposed procedural changes to managers.

Case Manager

UBC INC
04.2020 - 06.2021
  • Oversaw daily coordination of caseloads to ensure timely completion of all tasks.
  • Acted as primary contact for prior authorization and appeal processing communications.
  • Ensured accurate and timely communication of patient benefits and responsibilities.
  • Facilitated appropriate referrals for special programs/services based on patient needs.
  • Conducted quality checks on cases and reported trends to leadership.
  • Maintained organized records and effective housekeeping practices in technology.

Authorization Coordinator

Bioplus Specialty Pharmacy
01.2017 - 04.2020
  • Resolved denied claims by researching issues and contacting insurance companies.
  • Assisted in addressing client requests and internal operational challenges.
  • Reviewed insurance coverage to determine payment responsibility for patients.
  • Communicated with referral sources and patients to update on statuses.
  • Managed referrals on work list, ensuring communication within two hours of receipt.
  • Maintained spreadsheet for tracking purposes effectively.
  • Facilitated authorization processes for VIP clients regarding prescribed medications.
  • Conducted follow-up calls to insurance companies for authorization updates.

Verification Specialist, Billing & Reimbursement

CuraScripts/Express Scripts
01.2009 - 01.2016
  • Reviewed patient accounts to assess prescription coverage under medical insurance.
  • Ensured compliance with Medicare guidelines to mitigate company risk.
  • Managed account payments and verified insurance coverage for payment assurance.
  • Compiled data on new drug (Duopa) as lead reviewer, providing insights to upper management.
  • Served as team expert for Core/Oncology/Transplant therapies.
  • Assisted Pharmacy Service Representatives with escalated issues and customer service inquiries.
  • Collaborated with other departments to address customer needs effectively.
  • Supervised 15-20 representatives while performing quality audits and handling escalations.

Education

Associate - Arts/Medical Assistant

Branford Hall
Springfield, MA
08-2002

Skills

  • Communication skills
  • Problem solving
  • Customer service
  • Team collaboration
  • Leadership abilities
  • Motivation techniques
  • Adaptability strategies
  • Medicare and payer knowledge

References

Available upon request.

Affiliations

  • Fashion
  • Reading
  • Gardening

Languages

English
Professional

Timeline

Eligibility Supervisor/ Reconsideration Supervisor /Complaints Supervisor

Tidal Basin Consulting
07.2021 - Current

Case Manager

UBC INC
04.2020 - 06.2021

Authorization Coordinator

Bioplus Specialty Pharmacy
01.2017 - 04.2020

Verification Specialist, Billing & Reimbursement

CuraScripts/Express Scripts
01.2009 - 01.2016

Associate - Arts/Medical Assistant

Branford Hall

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Leslie Wiggins