MICHAEL MORAN-NGUYEN

• Navigate electronic medical record to leverage relevant progress notes, telephone encounters, and patient demographics
• Call payers and verify patient's insurance benefits, including assessing for authorization requirements on secondary insurance, if applicable
• Follow up with payers to check status of previously submitted prior authorizations
• Provide clear communication and documentation on status of prior authorization(s) to patient, multidisciplinary providers, and pharmacy
• Collaborate with multidisciplinary team to resolve prior authorization denials
• In charge of multiple clinics and the overall start to finish authorization process for medications, including but not limited to approvals, denials, appeals.
• Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.

Conduct benefit investigations, verify insurance coverage, and assist patients with navigating the insurance approval process for oncology specialty medications

Assist with the prior authorization process and work collaboratively with insurance companies to obtain coverage for specialty medications, reducing financial barriers to care for patients

Review complex insurance situations and provide education to patients, healthcare providers (HCPs), and staff on appropriate steps to access medications

Maintain local and national payer landscape knowledge, including medical and pharmacy benefits and Utilization Management criteria for assigned products.

• Adjudicated specialty medication claims, performed benefit investigations, and acted as a liaison between HCPs, pharmacies, insurance companies, and patients to ensure continuity of care
• Coordinated affordable patient copays through drug manufacturer copay cards, patient assistance programs, and alternative funding
• Educated providers on product fulfillment pathways, including buy and bill and specialty pharmacy options
• Provided educational resources and support throughout the patient journey, optimizing processes for prior authorizations, appeals, specialty pharmacy, and addressing access issues.

• Accurately and efficiently filled and dispensed medication orders under the supervision of a licensed pharmacist
• Processed insurance claims, managed patient profiles, and maintained medication records
• Resolved insurance rejections and other billing issues in a timely and efficient manner
• Maintained compliance with state and federal regulations and pharmacy policies and procedures.

• Learned leadership skills, developed a strong work ethic, and fostered values of safety, teamwork, and service to the country through service in the US Army Reserves
• Received, stocked, issued, and dispensed bulk and packaged products, including fuels and water, from storage and distribution facilities to units in need
• Operated specialized equipment in petroleum and water distribution systems and multi-product pipeline systems, adhering to regulations and submitting samples for laboratory testing to ensure high-quality product delivery.