Patrice L. Holmes

· Inbound or outbound phone calls to patients regarding complex Specialty medication orders

· Coordinated and processed requests for new and refill order shipments, verifying eligibility, prior authorization, and reimbursement requirements before shipment.

· Assisted in enrolling and tracking new customer referrals.

· Explained CVS/Specialty services to new customers and transferred/escalated clinical questions and issues to staff pharmacist for resolution.

· Offline project work task including but not limited to:

· Conducted training sessions for new staff on company protocols.

· Fertility

· BV (MAJ and Intake)

· Monitored FEP OTD data for compliance and performance reporting.

· MD Scheduling

· Patient Engagement

· Integrated efforts among cross-functional teams to achieve team goals.

· Account Solutions.

COE Teams: Fertility; REMS/PAH; IVIG

• Facilitated communication with providers by providing detailed and precise information regarding medical benefits coverage limitations and reimbursement policies.
• Conducted thorough analysis of medical claims discrepancies, facilitating communication between healthcare providers and internal departments to improve operational workflows.
• Articulated and conveyed critical claims information to providers, including deductibles, copayments, and network provider options.

• Utilized advanced virtual surveillance technology to monitor patients, enabling swift responses to potential safety incidents.
• Collaborated with healthcare teams to refine patient safety protocols, improving care for high-risk individuals.
• Documented clinical observations of patients hourly, maintaining accurate records of their condition.

• Facilitated training for new medical assistants to enhance adherence to company standards and improve team efficiency.
• Performed comprehensive chart audits to drive improvements in record accuracy and reliability.
• Administered patient medical records while maintaining rigorous adherence to HIPAA regulations, safeguarding confidentiality and data integrity.

• Directed a team of pharmacy benefits member service advocates, focusing on efficient claims processing and comprehensive member assistance.
• Coordinated weekly call calibrations with clients and account management team to strengthen communication channels.
• Facilitated mentorship for new and existing employees, enhancing team performance and precision.
• Oversaw task assignments and tracked productivity metrics to ensure alignment with department goals.
• Achieved enhanced team performance through effective evaluation and constructive feedback implementation. Facilitated significant improvements in team dynamics by implementing performance enhancement plans. Drove team success through comprehensive performance evaluations and tailored development plans.

• Conducted detailed verification of pharmacy benefits for inbound calls, addressing eligibility, formulary coverage, and medication alternatives.
• Streamlined prescription refill order workflow to support consistent medication adherence among patients.
• Resolved escalated calls, ensuring positive member experiences through effective concern resolution and solution identification.
• Elevated role from member service advocate to member service supervisor to oversee team performance and improve service delivery.

• Compiled detailed reports on incidents and patrol activities to ensure thorough documentation and enhance operational awareness.
• Executed armed foot patrols to safeguard designated interior and exterior areas.
• Executed strategies to prevent criminal behavior and uphold a secure environment.