Saquia McClain
Charlotte,North Carolina
Summary
Detail-oriented Patient Access Representative/Liaison with extensive medical services background and strong work ethic. Managed patient-related accounts in all interactions, with both external and internal customers. Excellent communications skills and empathetic nature enabled achievement of positive outcomes. Social and communicative with high regard for sensitive and confidential information. Clear understanding of HIPAA rules and insurance protocols.
Overview
20
20
years of professional experience
Work History
Patient Access Specialist/ARM HUB
The Lash Group
Fort Mill, South Carolina
06.2022 - Current
- Lead and facilitate calls with 3rd party contacts (and client, if applicable) to monitor patient progress, reconcile data discrepancies, research missing data, handle inquiries and provide updates as requested
- Create and maintain action log, agendas, and minutes for each meeting lead
- Handle inbound/outbound calls from all applicable customers including but not limited to 3rd party contacts, client contacts, third party vendors and internal team resources
- Triage and/or approve work referrals to 3rd parties as needed
- Reference and implement business requirements as it pertain to operating procedures, validation of incoming data from 3rd party, and identifying and escalating data feed issues internally and externally
- Identify needed system enhancements and/or reports and participate in requirement review, testing and implementation
- Implement business requirements for newly contracted 3rd party interfacing with program(s) supported to ensure adherence to all contractual obligations; ensure all data is validated prior to program launch
- Share best practices and learning opportunities with program implementations and peers
- Effectively conveys information and ideas
- Identifies problems, investigates, recommends ,and implements solutions
- Identifies and recommends innovative solutions to improve and streamline current processes
- Responsible for overall project delivery, ensuring projects meet key milestones and deliverables and removing obstacles on multiple concurrent projects
- Determines best approach for projects being executed
- Escalates when appropriate
- Ensures quality and integrity of project work.
Patient Case Coordinator
The Lash Group
Fort Mill, SC
04.2012 - Current
- Provides exceptional customer service to internal and external customers
- Resolves any customer requests in timely and accurate manner; escalates complaints accordingly
- Answers basic program inquiries
- Coordinates access to therapies through patients' healthcare providers
- Processes incoming enrollment forms
- Conducts patient eligibility assessments
- Ensures that information is accurately obtained and documented in detail in program
- Schedules and conducts appropriate follow-up based on each patient's situation
- Identifies other sources of health care coverage and copay assistance for patients
- Facilitates access to appropriate support services, including reimbursement counseling and other support
- Follows up via phone, mail, and/or fax for missing enrollment information
- Supports payer research, health care policy library, and state management
- Performs related duties as assigned.
Senior Reimbursement Counselor
The Lash Group
Fort Mill, South Carolina
04.2013 - 06.2022
- Benefit Verifications, Prior Authorization Support, Copay assistance prescreening and eligibility determination,
- Patient Assistance Program prescreening and eligibility determination, Shipment coordination with Specialty Pharmacies, Alternate Coverage Research
- Advance experience in claims research through claims 1500 and UB04 form processing
- Communicate with Field Reimbursement Manager regarding patient record and treatment dates Reviewed and updated standard operating procedures for management
- Created new quality metrics for improving overall efficiency throughout team and for team database
- Ability to run reporting system for pending and completed items on task list for current team
- Responsible for quality review process for benefit verifications and fax reviews
- Responsible for copay and PAP determination process
- Assigned as Quality Ambassador for current team
- Created and implemented order processing structure for specific specialty treating site
- Ability to work independently and be highly accountable
- Excellent time management skills
- Good problem-solving skills and ability to prioritize
- Demonstrate superior customer service, teamwork and responsiveness to client/customers
- Demonstrate effectiveness in training, mentoring and providing feed back to colleagues
Hewitt Associates, BenefitsSpecialist
Charlotte, NorthCarolina
09.2010 - 06.2011
- Enrolled client’s employee in health benefits, which included medical, dental, vision, LTD,
- STD, Flexible Spending accounts and life insurance
- Researched inquiries and opened workflow cases to have clients’ information corrected appropriately
- Acquires and maintains technical and professional knowledge and skills required to effectively to provide full array of services to clients
- Provides excellent customer service in timely manner.
Education
Bachelor of Science - Criminal Justice
Fayetteville State University
Fayetteville, NC06.2003
Master of Health Service - Health Administration
Strayer University
Washington, DC08.2012
Skills
- Regulation Compliance
- Salesforce
- Patient Reimbursements
- Patient Plus, Emerald, Rumba, Einstein,
- Project Coordination,
- Workflow Delegation
- Customer Service
- Data Analysis
- Quality Standards and Protocols
- Conflict Resolution
- Team Leadership
- Database Search and Data Entry Skills
Accomplishments
- Collaborated with team of 10 in the development of the Benefit Verification Training
- Achieved the role of AM HUB Liaison by completing assigned task-list with accuracy and efficiency.
Languages
English
Timeline
Patient Access Specialist/ARM HUB
The Lash Group
06.2022 - Current
Senior Reimbursement Counselor
The Lash Group
04.2013 - 06.2022
Patient Case Coordinator
The Lash Group
04.2012 - Current
Hewitt Associates, BenefitsSpecialist
09.2010 - 06.2011
Bachelor of Science - Criminal Justice
Fayetteville State University
Master of Health Service - Health Administration
Strayer University
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