Salesforce
Maya Ridley
Martinsburg,WV
Summary
Top-performing payer and reimbursement expert specializing in Specialty and Biologics with a proven ability to drive efficiency, deliver successful outcomes and collaborate within cross-functional teams. Expert in commercial and government payers, worker's
compensation, buy and bill, claims reimbursement and denial management, prior authorizations, specialty pharmacies, and Misc J Codes.
Overview
7
7
years of professional experience
Work History
Patient Access Navigator
AstraZeneca
01.2019 - Current
- Exercised strong decision-making skills during high-stress emergency scenarios while adhering to company policies and procedures.
- Leverage my expertise in payer trends, policies, and reimbursement to minimize reimbursement barriers for patients and providers.
- Create and manage a large database of national and regional payer coverage trends and policies for two therapeutic areas that are utilized by multiple USPS counterparts, create and update Benefit Investigation script language for clarity or specific payer trends.
- Payer expert on commercial, Medicare and Medicaid policies, state-funded programs, and Worker’s Compensation; extensive experience with claims reimbursement, CMS 1500 forms, product launches (both Enhertu,, Infinzi, Imjudo and Misc J and Codes.
- Educate providers and onboard key accounts, provide appropriate solutions regarding available support resources to coordinate timely access to AstraZeneca therapies.
- Serve as the primary point of contact while collaborating and strategizing with FRM (both in office and on field rides), establish customer touch points, and provide outstanding customer service.
- Onboard key accounts and compliantly educate healthcare professionals on process, policies, pathway options, payer mandated specialty pharmacies, etc.
- Manage patient and provider accounts and support requests across multiple communication channels to coordinate personalized assistance for high volume territories.
- Develop strong relationships with healthcare professionals and patients to identify both account and customer needs, facilitate patient access to products, and coordinate hands-on support.
- Establish strong, collaborative relationships across several internal departments and cross-functional partners and manage external communications with payers, pharmacies, and third-party vendors to facilitate resolutions in a timely and effective manner.
Patient Access Specialist
AstraZeneca
02.2018 - 01.2019
- Maintained patient confidentiality by adhering to HIPAA guidelines and hospital policies.
- Provided exceptional customer service, addressing patient concerns promptly and professionally.
- Collected and entered patient demographic and insurance data into CRM database to establish patient's medical record.
- Handled sensitive situations involving distressed patients with empathy maintaining professionalism throughout interactions.
- Ensured timely and accurate case management and resolution for all support requests.
- Launched Fasenra with misc J Code, which included performing detailed and thorough insurance Benefit Investigations, including Prior Authorization requirements, appeal processes, and specialty pharmacy coordination.
Assistant Reimbursement Manager
AmerisourceBergen
01.2017 - 12.2017
- Developed strong relationships with insurance companies and healthcare providers, fostering collaboration and ensuring smooth communication for reimbursement matters.
- Maintained up-to-date knowledge on national healthcare policies affecting reimbursements, advising senior leadership on necessary adjustments or updates to internal processes accordingly.
- Facilitated cross-functional meetings to discuss the impact of policy changes on the reimbursement process, ensuring clear understanding among all stakeholders.
- Continually revised strategies based on analysis of KPIs results, leading efforts towards continuous improvement within the reimbursement department.
- Held weekly staff meetings and implemented team building exercises, which promoted positive working environment.
- Increased efficiency in the reimbursement process by implementing streamlined procedures and guidelines.
- Implemented new software solutions to automate aspects of the reimbursement workflow, increasing overall productivity.
- Observed strict data confidentiality procedures to protect patients' information.
- Managed a team of reimbursement specialists, providing guidance and support for optimal performance.
- Conducted regular audits of reimbursement activities, identifying areas for improvement and implementing corrective actions as needed.
- Mentored junior team members to develop their skills and knowledge within the field of reimbursement management.
- Developed comprehensive training materials for new hires, resulting in a more efficient onboarding process.
- Compiled department-specific reports to help senior managers identify trends and improve progress.
Education
Health Administration
American InterContinental University
Schaumburg, ILSkills
- Biologics and Specialty Meds
- Claims reimbursement
- Payer policy and trends
- Education and presenting
- Critical thinking skills
- Excellent communication skills
- Strong interpersonal skills
- Proactive and self-motivated
- Time Management
Software
Timeline
Patient Access Navigator
AstraZeneca
01.2019 - Current
Patient Access Specialist
AstraZeneca
02.2018 - 01.2019
Assistant Reimbursement Manager
AmerisourceBergen
01.2017 - 12.2017
Health Administration
American InterContinental University