Open To Work
Neftali Martinez
Case Manager/ Reimbursement
orlando,Florida
Some people want it to happen, some wish it would happen, others make it happen.
Michael Jordan
Work Preference
Job Search Status
Open to workDesired start date: Open to discussion
Desired Job Title
Case Manager, Reimbursement, BioMarin RareConnectionsReimbursement Analyst/Case Manager and Promoted to Patient Access ManagerDispute Resolution Department InvestigatorPatient Access SpecialistInsurance Verification CoordinatorWork Type
Full TimeLocation Preference
HybridOn-SiteRemoteSalary Range
$65000/yr - $200000/yrSummary
Dedicated healthcare professional committed to supporting patient access and delivering high-quality service.
Eager to collaborate with multidisciplinary teams, utilize innovative technologies, and contribute to improved patient outcomes.
Overview
9
9
years of professional experience
Work History
Case Manager, Reimbursement, BioMarin RareConnections
UBC-United BioSource Corporation
Lake Mary, Florida
11.2025 - 03.2026
- Temporary Opportunity
- Coordinated day-to-day oversight of caseload, ensuring timely completion of all case elements and smooth progression through the process.
- Served as primary contact for prior authorization and appeal processing, facilitating communication among patients, healthcare providers, field reimbursement representatives, and external stakeholders.
- Troubleshot complex cases across multiple disease-states, collaborating with key stakeholders to secure optimal therapy initiation.
- Assess and refer patients appropriately for special programs/services when appropriate.
- Performs quality checks on cases and report trends to leadership.
- Report Adverse Drug Events that have been experienced by the patient in accordance with pharmaceutical requirements.
- Recognize a product quality complaint and forward caller/written information to a manufacturer.
Reimbursement Analyst/Case Manager and Promoted to Patient Access Manager
Occam Health Services
05.2024 - 11.2025
- Collaborated with health care providers (HCPs) to address coverage and reimbursement questions, facilitating patient access to medication.
- Educated stakeholders on access and affordability solutions across various payer types and plans (i.e., Medicare, Medicaid, managed care, commercial).
- Shared insights into customer needs and payer issues with team members, including Patient Services partners and Field Sales.
- Managed case files for enrollments, prior authorizations, formulary exceptions, and claims assistance, ensuring timely resolution of patient needs.
Dispute Resolution Department Investigator
CardWorks
11.2021 - 05.2024
- Processed new claims, updating cardholders on status and resolution to enhance customer satisfaction.
- Researched and investigated customer accounts for billing errors, ensuring compliance with regulations and addressing discrepancies.
- Conducted thorough investigations into customer disputes and complaints.
- Analyzed data to identify trends and patterns in fraud cases.
- Collaborated with cross-functional teams to improve investigation processes.
Patient Access Specialist
AssistRx
06.2019 - 11.2021
- Confirmed patient insurance coverage, processed copays, and managed prior authorizations, formulary exceptions, and claims assistance to ensure seamless patient access to services.
- Identified and resolved issues related to insurance coverage, eligibility, and billing, improving overall resolution efficiency and supporting timely patient care.
- Interacted with patients, families, and healthcare staff to relay information, answer questions, and address concerns, enhancing patient experience and satisfaction.
Insurance Verification Coordinator
Acaria Health
08.2018 - 06.2019
- Verified insurance eligibility, coordinated prior authorizations, processed formulary exceptions, and assisted with claims to ensure seamless patient access to required services.
- Managed inbound calls from patients, healthcare providers, and insurance companies to facilitate clear communication and resolve inquiries efficiently.
- Provided comprehensive education to patients regarding their insurance benefits to empower informed decision-making.
- Collaborated with healthcare providers to ensure proper billing procedure.
Benefit Verification Specialist
Mckesson
12.2017 - 08.2018
- Handled inbound calls from patients and healthcare providers, facilitating clear communication and resolving inquiries with insurance companies.
- Educated patients on their insurance benefits, empowering them to make informed decisions regarding their healthcare options.
- Performed insurance eligibility verification, processed prior authorizations, managed formulary exceptions, and provided claims assistance to ensure patients received necessary treatments.
- Collaborated with healthcare providers to ensure proper billing procedure.
Benefit Verification Specialist
CVS Health / Rx Crossroads
10.2016 - 12.2017
- Coordinated insurance eligibility verification, prior authorizations, formulary exceptions, and claims assistance to ensure timely patient access to necessary medications.
- Verified patient benefits for medication coverage and eligibility.
- Collaborated with healthcare providers to gather necessary documentation.
- Reviewed insurance policies to ensure compliance with regulations.
Education
B.S. - Marketing and Advertising
Skills
- Case management
- Prior authorization
- Insurance verification
- Clinical documentation
- Payer collaboration
- Data analysis
- Patient education
Value Offered
Dedicated professional ready to contribute to the dynamic healthcare team. Eager to collaborate with colleagues, leverage emerging technologies, and make meaningful impacts on individual lives.
Timeline
Case Manager, Reimbursement, BioMarin RareConnections - UBC-United BioSource Corporation
11.2025 - 03.2026
Reimbursement Analyst/Case Manager and Promoted to Patient Access Manager - Occam Health Services
05.2024 - 11.2025
Dispute Resolution Department Investigator - CardWorks
11.2021 - 05.2024
Patient Access Specialist - AssistRx
06.2019 - 11.2021
Insurance Verification Coordinator - Acaria Health
08.2018 - 06.2019
Benefit Verification Specialist - Mckesson
12.2017 - 08.2018
Benefit Verification Specialist - CVS Health / Rx Crossroads
10.2016 - 12.2017
University of Puerto Rico - B.S., Marketing and Advertising