Sarah Trottier
Whitinsville,MA
Summary
Versatile Health Insurance/ Pharmacy Intake Specialist with results-driven and focused approach to completing work. Skilled team leader, planner and problem-solver with 20 year career in Healthcare. Known for excellent attention to detail and great work ethic.
Overview
16
16
years of professional experience
1
1
Certificate
Work History
Pre-Authorization Specialist
Boston Scientific
Remote
11.2021 - Current
- Perform initial benefit verification and pre-surgical authorization for new pre-surgical cases by working closely with all payers
- Understands medical criteria guidelines and works with all parties to resolve denied cases in an effort to overturn the unfavorable outcome
- Document case status, actions, and outcome in the Pre-Authorization Support contact management database utilizing who, what, where, when, how
- Communicates and build relationships with physician offices and sales representatives in regards to all inquiries for the handling of cases including, missing case information, missing clinical documentation, relaying benefit details and patient responsibility.
- Responsible for notifying the appropriate internal departments based on receipt of information that department needs to be aware of including complaint handling/ adverse event notifications
- Participated in ongoing training and compliance activities.
- Coordinated with other departments to ensure efficient workflow processes.
- Exercised versatility in fast-paced, agile work environments.
- Coordinated and managed various programs or projects to achieve established objectives.
- Utilize customer service skills in engaging with customers, communications with Sales representatives, and working in teams in a call center environment to expedite processing of cases. Answer incoming calls received through the Pre-Authorization Support line and provide appropriate call/case handling.
Intake Specialist Lead
Option Care Enterprises
Marlborough, MA
12.2017 - 12.2021
- Assisted with training new staff members on pre-authorization processes and protocols.
- Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
- Resolved escalated customer complaints or queries promptly and efficiently.
- Identified opportunities for process improvements, implementing changes when required.
- Monitored team performance against targets, taking corrective action where necessary.
- Maintained a positive work environment that promoted collaboration between team members.
- Participated in regular meetings with senior leadership to provide updates on team progress.
- Coordinated team activities and delegated tasks to ensure efficient completion of projects.
- Established clear expectations for employees, providing guidance when needed.
- Provided coaching and feedback on employee performance, encouraging professional development.
- Resolved customer complaints in an effective manner while maintaining a high level of customer service.
- Developed strategies for problem solving and conflict resolution among team members.
Intake/Authorizations Specialist/Lead Intake Coordinator
BioScrip Home Infusion.
Southborough, MA
01.2012 - 12.2016
- Complied with reimbursement for products and services in compliance with policies and goals, to include drug, supply and equipment selection and utilization.
- Ensured the submission of clean claims through compliance to proper pharmacy billing procedures.
- Reviewed and verified patient insurance coverage to ensure authorization criteria were met.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Interpreted clinical information into appropriate coding systems for review by payers.
- Addressed inquiries from providers regarding status of authorization requests.
- Assessed the medical necessity of requested services in accordance with payer policies.
- Collaborated with providers, payers and members to obtain prior authorizations for services and resolved issues related to prior authorization process with payers and other entities.
- Maintained detailed records of pre-authorization requests and denials and processed appeals for denied claims in a timely manner while adhering to regulatory standards.
- Monitored changes in provider contracts, policies, procedures, and regulations as they pertain to prior authorizations.
- Conducted research on complex cases involving multiple medications or treatments when needed.
- Researched alternative funding sources when required prior authorizations are denied.
- Analyzed data pertaining to authorization volume, turnaround times, accuracy rate for reporting purposes and ensured that all necessary documentation was submitted for approval processes.
- Resolved issues related to pre-authorization process with payers and other external entities.
- Promoted to leadership position in recognition of strong work ethic and provided exceptional customer service.
Patient Service Coordinator
BioScrip Home Infusion
Southborough, MA
08.2009 - 12.2011
- Responsible for overall coordination and processing of patient medication orders, to include order intake within regulatory boundaries, patient services coordination, and pharmacy technician duties while under the supervision of a pharmacist
- Enter new prescriptions into the pharmacy computer system
- Process prescription refill and generate the refill documentation
- Generate delivery and pick-up tickets according to patient’s needs
- Communicate with patients to determine general health status, medication compliance, drug and supply inventory, and overall coordination of care and service
- Gather, organize, document, and report clinical data for review and action by the pharmacist, nurse, prescriber (i.e.: lab data, results of patient contact and hospitalizations)
- Track controlled substance prescriptions requiring prescriber signature
- Assist in maintaining the accuracy of supply templates.
Nursing Coordinator
Bioscrip Home Infusion
Southborough, MA
12.2007 - 08.2009
- Perform coordination of admission information of infusion patients from the initial call or fax
- Provide insurance verification and revenue qualification
- Accept patients according to payer guidelines and Company policies and procedures In conjunction with pharmacy, nursing, and distribution, is responsible for coordinating the initial start of care
- Interact with patients, physicians, referral sources, case managers and primary nurses in order to ensure appropriate, cost effective patient care
- Obtains and documents all pertinent demographic and insurance information
- Reviews new patient information for appropriateness, confers with pharmacy and informs case managers of any identified financial issues
- Documentation of internal and external communication according to company policy
- Enters patient information into database including but not limited to demographics, insurance information and authorizations
- Obtains necessary information required for obtaining initial authorizations and ongoing authorizations as needed
- Keep current on all reimbursement changes for commercial and government payers
- Comply with all applicable company policies and procedures
- Takes on-call responsibility as assigned.
Education
Uxbridge High School
06.1998
Skills
- ICD-10
- Medical Terminology
- Auditing
- Medical Office Experience
- ICD Coding
- CPR (10 years)
- Quality Assurance
- Phone Etiquette
- Transcription
- EMR Systems
- Supervising Experience
- CPT Coding
- Hospital Experience
- Medical Coding
- Anatomy Knowledge
- Documentation Review
- Employee Orientation
- Triage
- Meditech (5 years)
- Epic
- Waystar (5 years)
- Patient Care
- HIPAA
- Prior Authorization
- Microsoft Powerpoint
- Pharmacy Technician
- Laboratory Experience
- Nursing Coordination
- Medical Scheduling
- Pharmacy Technician Experience
- Medical Records
- Medical Billing
- Insurance Verification
Certification
- Pharmacy Technician (previously held - has since expired)
Timeline
Pre-Authorization Specialist
Boston Scientific
11.2021 - Current
Intake Specialist Lead
Option Care Enterprises
12.2017 - 12.2021
Intake/Authorizations Specialist/Lead Intake Coordinator
BioScrip Home Infusion.
01.2012 - 12.2016
Patient Service Coordinator
BioScrip Home Infusion
08.2009 - 12.2011
Nursing Coordinator
Bioscrip Home Infusion
12.2007 - 08.2009
Uxbridge High School
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