Rachel Baron
Orlando,FL
Summary
Reimbursement Specialist experienced in benefit investigation, prior authorization, payer reimbursement, and patient access. Strong knowledge of Medical‑Pharmacy Benefit Management and Managed Care policies. Skilled in resolving insurance barriers, coordinating financial assistance, and improving workflow efficiency.
Overview
10
10
years of professional experience
Work History
Reimbursement Specialist
UBC LLC — Remote
Lake Mary, Florida
02.2025 - Current
- Evaluated coverage, deductibles, and carrier payments to explain patient financial responsibility, securing financial support through copay programs and PAP enrollment.
- Acted as the primary contact for inbound inquiries from providers, patients, payers, and external partners, coordinating responses to support smooth case progression.
- Performed benefit request investigations via test claim, eBV, CMM Cover My Med, Availity and phone verification, providing prescriber offices with precise coverage and authorization outcomes.
- Triaged and responded to calls from patients, insurance companies, physicians, sales representatives, pharmacies, and homecare agencies, providing clear guidance.
- Coordinated product orders and confirmed shipment details between pharmacy and patient, initiating therapy to prevent delays.
- Engaged in scheduled conference calls with client teams, FRMs, and prescriber offices to discuss case status and drug orders, ensuring accurate documentation and timely follow-up.
- Assisted with inquiries related to the Manufacturer/Client HCP Portal, addressing issues and providing navigation support during demonstrations.
- Ensured compliant, accurate documentation by entering and maintaining data in client databases, monitoring outstanding case items, and completing files for clear status evaluations.
Reimbursement Manager
BioSolutia / CareMetx LLC Remote
Lake Mary, Florida
07.2018 - 02.2025
- Coordinated prior authorization and appeal documentation for prescriber offices, ensuring complete, accurate, and timely submissions to payers.
- Completed comprehensive benefit investigations with PBMs and medical plans to determine coverage, authorization criteria, and appeal options.
- Contacted HCPs and patients to communicate benefit investigation outcomes and guide next steps for timely medication access.
- Evaluated financial assistance options through copay assistance program and various foundations to support patient access.
- Supported prescriber offices by troubleshooting HCP portal issues, offering navigation assistance, and leading demonstrations to streamline case management.
- Analyzed data inputs to resolve moderate-scope issues while ensuring compliance with SOP guidelines.
Insurance Verification Specialist
AcariaHealth/UHC
Orlando, Florida
04.2016 - 03.2018
- Secured clinical data for prior authorizations, documented financial responsibility per insurance guidelines, coordinated benefits, ensured assignment of benefits for Medicare claims, and submitted compliant billing for therapies provided to facilitate accurate reimbursement.
- Completed benefit investigations with the Medical and/or Pharmacy Benefit Manager (PBM) for coverage and obtained authorization information and Appeal information.
- Supported prescriber’s office by efficiently managing prior authorization reviews and submissions to facilitate patient access to medications.
- Assisted prescriber’s office with appeal documentation and submission to appropriate entity, improving chances for successful appeals.
- Evaluated patient needs and coordinated reimbursement resources—including copay cards, third‑party programs, and manufacturer assistance—to minimize out‑of‑pocket costs for patients.
- Managed inbound calls related to benefit eligibility and prescription status, ensuring timely, precise responses to support smooth case completion.
Education
High School Diploma -
Whitney M. Young, Jr. Job Corps Center
Simpsonville, KY03-2004
Diplomas: Heath Unit Coordination, Medical Office Support And Medical Office Clerk. - Health Administration
Whitney M. Young, Jr. Job Corps Center
Simpsonville, KY03-2004
Some College (No Degree) - Health Information Management
Valencia College
Orlando, FLSkills
Benefit investigation and prior authorization
Appeals and denial resolution
Insurance verification and eligibility
Payer reimbursement strategies
Claims resolution and copay assistance
Financial assistance assessment
Authorization tracking and patient advocacy
Provider and pharmacy liaison
HCP portal navigation and troubleshooting
Healthcare coordination and communication
Customer service excellence
Claims management for Medicare, Medicaid, and commercial plans
Chronic disease management
Timeline
Reimbursement Specialist
UBC LLC — Remote
02.2025 - Current
Reimbursement Manager
BioSolutia / CareMetx LLC Remote
07.2018 - 02.2025
Insurance Verification Specialist
AcariaHealth/UHC
04.2016 - 03.2018
High School Diploma -
Whitney M. Young, Jr. Job Corps Center
Diplomas: Heath Unit Coordination, Medical Office Support And Medical Office Clerk. - Health Administration
Whitney M. Young, Jr. Job Corps Center
Some College (No Degree) - Health Information Management
Valencia College