Neftali Martinez
Summary
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
Overview
10
10
years of professional experience
Work History
Case Manager, Reimbursement, BioMarin RareConnections
UBC-United BioSource Corporation
Lake Mary, Florida
10.2025 - 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
04.2024 - 10.2025
- 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
10.2021 - 04.2024
- 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
05.2019 - 10.2021
- 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
07.2018 - 05.2019
- 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
11.2017 - 07.2018
- 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
09.2016 - 11.2017
- 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
University of Puerto Rico
Skills
- Case management
- Prior authorization
- Insurance verification
- Clinical documentation
- Payer collaboration
- Data analysis
- Patient education
Name
Hi, I’m
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
10.2025 - 03.2026
Reimbursement Analyst/Case Manager and Promoted to Patient Access Manager
Occam Health Services
04.2024 - 10.2025
Dispute Resolution Department Investigator
CardWorks
10.2021 - 04.2024
Patient Access Specialist
AssistRx
05.2019 - 10.2021
Insurance Verification Coordinator
Acaria Health
07.2018 - 05.2019
Benefit Verification Specialist
Mckesson
11.2017 - 07.2018
Benefit Verification Specialist
CVS Health / Rx Crossroads
09.2016 - 11.2017
B.S. - Marketing and Advertising
University of Puerto Rico