Mya Ford
Memphis,TN
Overview
4
4
years of professional experience
Work History
Contract Benefits Verification Specialist
Amgen
10.2023 - Current
- Taking calls and outreach from health care professionals (HCPs) and entering data into supporting systems to initiate enrollment of new and existing patients
- Initiating benefits verification by reviewing patient data and insurance material, including identifying missing information and following up with points of contact to resolve information gaps
- Verifying benefits for each assigned patient case and detailing any requirements for reimbursement including copays, coinsurance, utilization management requirements, qualifications / restrictions, and prior authorization requirements
- As applicable, initiating subsequent actions (e.g
- Prior authorizations, appeals, travel and appointments)
- Monitoring potential delays or pended cases, and identifying and documenting lessons learned and potential leading practices resulting in shorter processing times or higher success rates
- As required, supporting new initiatives and process improvement activities (e.g
- End user testing of new system features and supporting technology)
- Understanding, and adhering to, government regulations and company policies
- Maintains positive rapport with internal and external customers through effective communication and active listening
- Able to remain agile with multiple plan designs and call types.
Reimbursement Specialist
Unified
05.2021 - 10.2023
- Develop spreadsheets, proper document formatting, database entry in support of programs, preparing agendas, documenting minutes from meetings, and preparing
- Work with HIPPA, insurance verifications and legal documents
- Update and enter data into all accounts
- Ability to work solely independently to follow detailed workflows and escalate when necessary
- Implement, coordinate, and complete tasks on deadline driven system
- Detail oriented and excellent in maintaining high quality on repetitive tasks workflows
- Policy implementation to a team of 10
- Maintained internal and external client relationships for 30+ organizations
- Streamlined client frustrations and feedback to senior level management
- Contact insurance payers, employers, or responsible parties to collect on outstanding accounts receivables
- Identify and resolve improper payments, incorrect denials, billing errors and payer discrepancies
- Read EOB (Explanation of Benefits) to determine next actionable events/items
- Use Client System (Cerner) to obtain medical documentation for patients
- Use RCI (Revenue Cycle) to obtain payment information for outstanding bills
- Compile accurate and effective appeals and disputes to the appropriate payers and state divisions
- Contact insurance payers, employers, or responsible parties to collect on outstanding accounts receivables
- Identify and resolve improper payments, incorrect denials, billing errors and payer discrepancies
- Read EOB (Explanation of Benefits) to determine next actionable events/items
- Use Client System (Cerner) to obtain medical documentation for patients
- Use RCI (Revenue Cycle) to obtain payment information for outstanding bills
- Compile accurate and effective appeals and disputes to the appropriate payers and state divisions.
Patient Care Advocate
Accredo
08.2020 - 05.2021
- Handled customer service inquiries from members, providers, physicians and internal and external clients related to pharmacy benefits
- Researched and resolved problems in a timely manner
- Assisted members with understanding and maximizing the use of their pharmacy distribution program
- Used computerized system to gather information and respond to questions
- Documented issues and resolutions in a common database
- Escalated issues as necessary.
Education
General Studies
Germantown High School
Germantown, TN05.2018
Skills
- Accuracy and Precision
- Data Entry
- Policy Interpretation
- Verbal and written communication
- Adaptability
- Billing verification/ Invoices
Timeline
Contract Benefits Verification Specialist
Amgen
10.2023 - Current
Reimbursement Specialist
Unified
05.2021 - 10.2023
Patient Care Advocate
Accredo
08.2020 - 05.2021
General Studies
Germantown High School