Lucrece Chaizeu

. Analyze and prepare monthly internal reports for Operation Leadership and Senior Program Manager (SPM) which provide trends and correlating root causes
. Prepare and delivers complex quarterly compliance reports by collecting, analyzing and summarizing information
. Collaborate with quality team members to identify and streamline processes and implement process standards that enhance service delivery and the customer experience
. Facilitate bi-weekly call calibration sessions with Quality Assurance, Training and Operation Leadership to ensure consistency of expectations and standards
. Provide structured and timely recommendations; verbal and/or written feedback to management teams
. Ensure team members are complying with policies and procedures, program-specific operating procedures, and governmental regulatory policies including HIPAA
. Conducts internal weekly audits to measure and assure adherence to standards, compliance processes and policies
. Identify, assess and incorporates best practices to ensure compliance with all regulatory requirements
. Organize, manage and improve overall quality functions within the program by working closely with management teams
. Perform certifications for new hires post-training to determine knowledge gained and readiness
. Formulate and manage the development and implementation of goals, objectives, and procedures for the quality team
. Provide data and trends to various internal support groups as needed
. Investigate and provides corrective action and preventative actions (CAPA)
. Use a monitoring system, CSI Virtual Observer and Nice inContact CXone, to gather data and analyze trends or patterns affecting the quality

. Manage day to day activities of health care provider support requests
. Serve as a resource for Health Care Providers and patients and use regional reimbursement, distribution and payer policy expertise to provide solutions for complex patient access situations, working closely with the PAA team to appropriately escalate/resolve issues.
. Perform in-depth research into patient's insurance, prior authorization and appeal requests on behalf of the provider.
. Educate offices on Access 360 programs and referral process to ensure timely case processing

. Manage day to day activities of health care provider support requests
. Serve as a resource for Health Care Providers and patients and use regional reimbursement, distribution and payer policy expertise to provide solutions for complex patient access situations, working closely with the PAA team to appropriately escalate/resolve issues.
. Perform in-depth research into patient's insurance, prior authorization and appeal requests on behalf of the provider.
. Educate offices on Access 360 programs and referral process to ensure timely case processing

· Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.

· Establishes themselves as regional experts regarding payer trends and reports any reimbursement trends/delays to management team (e.g. billing denials, claim denials, pricing errors, payments, etc.).

· Processes any necessary correspondence.

· Coordinates with internal and external service providers to ensure services are performed in accordance with program policy and within expected service level agreements (SLA’s).

· Maintains confidentiality in regards to all patient sensitive information.

· Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.

· Required to be self-motivated, working from a queue (phone or system). Expected to perform work in accordance with defined standard operating procedures. Management will monitor queues and provide active feedback as required.

· Performs related duties as assigned, which could include well defined services generally performed by other program representatives (e.g. benefit verifications, Patient Assistance Program determinations).

· Applies company policies and procedures to resolve a variety of issues.

• Assisted several customers per day with medical billing inquiries.
• Referred customers to organizations that may provide financial assistance.
• Researched patient benefits to assist with insurance questions.
• Investigated medical history, coding, and insurance coverage to determine reimbursement eligibility.
• Investigated medical history, coding, and insurance coverage to determine reimbursement eligibility.

• Resubmitted claims with new and amended information to insurance companies for processing.
• Assist several customers per day with medical billing inquiries.
• Investigated medical history, coding, and insurance coverage to determine reimbursement eligibility.
• Referred customers to organizations that may provide financial assistance.
• Researched patient benefits to assist with insurance questions.