MARNIE CRAWFORD

As a team member on Genentech's Speaker Bureau, I am invited by Field Reimbursement Managers to speak to practices all over the country about resources for their patients out of pocket costs for medications, access and reimbursement.

• Copay assistance for commercially insured patients.
• Referral to non-profit organizations such as, the Chronic Disease Fund, PANF and the Health Well foundation for Medicare patients.
• Directed referral to Genentech's foundation to provide Free drug for patients whom are uninsured or under insured.
• Provide educational material related to patient specific diseases.
• Direct practices on how to get samples and/or replacement drugs for patients whom insurance refuses to reimburse practices after they have done due diligence.
• I also assist administrative and billing staff members with questions or problems arising from carrier reimbursement. In particular, temporary Jcode claims or bilateral injections that are not paid correctly. Buy and bill vs. specialty pharmacies.

• Developed and implemented strategic plans to support medical best practices creating a thriving revenue stream while being mindful of patient out of pocket costs.
• Responsible for human resource functions including, but not limited to the selection, training, evaluation, disciplinary action, complaints, payroll, 401K, benefits and compensation recommendations etc.
• Researched and designed job titles utilizing the FLSA to determine exempt status and work responsibilities in order to create a healthy fun work culture that spotlights accountability with the goal being limited turnover creating trust with patient relationships.
• Directly responsible for the financial health of the practice. Including budgetary functions, vendor contract negotiations, expenditure authorization, general ledger reporting and carrier analysis in order to maintain a healthy, profitable revenue cycle.
• Managed all aspects of the practice both clinically and operationally reducing expenditures by over 25% in the first year of my employment and recovering over $300,000 that had been written off as "bad debt".
• Trained new employees and staff to meet all standards and guidelines set forth for infection control related to Coved 19. CPR and first aid certification every two years.
• Managed revenue cycle including; carrier contract negotiations, maintaining fee schedules, claim scrub, clearing house transmissions, denial appeals, medical record documentation for medical necessity, carrier maintenance, patient statements and collections.
• Assisted patient phone calls for billing questions, provided educational materials and applications for copay assistance with commercial carriers OR non profit organizations that provided grant assistance for medicare patients.
• Managed and implemented electronic health record (EHR) and PM software conversion and training for CMS, MACRA/MIPS compliance and quality initiatives.
• Developed and implemented policies and procedures, employee handbooks and benefits for annual open enrollment.
• Assisted with budgetary development by providing in-depth analysis of current carrier local coverage determinations, CMS fee for service reimbursements, physician production and clinic growth projections.
• Oversee and maintain physician credentialing with insurance carriers.
• Developed an inventory system for high cost injectables and trained retina technician supervisor to order injectables and oversee all inventory numbers for all three locations.
• Extensive knowledge of carrier requirements for prior authorizations, step edits and introduction of temporary J-codes related to new injectables entering the market.