Selma Plavulj
North Chicago,IL
Summary
Experienced with patient registration, insurance verification, and managing patient inquiries. Uses effective communication to ensure seamless patient interactions and adherence to healthcare protocols. Track record of enhancing patient satisfaction through efficient and compassionate service.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Patient Access Specialist I
Abbvie
North Chicago, IL
08.2022 - Current
- Investigate patients’ insurance coverage by conducting payer calls, utilizing insurance intel and webtools.
- Review financial documents to assist with assessing program eligibility.
- Provide subject matter expertise on medical and prescription insurance coverage, medication prior authorization process and alternate financial assistance opportunities.
- Highly proficient in insurance verifications across various insurance carriers such as commercial/employer/marketplace plans, Medicare, Medicaid, and Military plans.
- Conduct the outreach process to obtain missing information that is required to complete an application assessment.
- Receive and handle incoming calls from patients, HCPs, and internal business agents.
- Complete renewal and year end recertifications process.
- Created and shared 'Fun Fact Friday' emails with the patient access team providing them with process flow information, reminders, and fun facts that can assist agents in processing an application.
- Piloted the Alternate Funding Commercial insurance application process.
Patient Care Coordinator I
AbbVie
North Chicago, IL
04.2015 - 08.2022
- Answer questions or concerns patients have regarding qualification guidelines, deliveries, prescriptions, and/or approval to the Patient Assistance Program (PAP).
- Support leadership and management team on the NxTGEN project.
- Integral member of the HyperCare Team for Five9. Facilitate with testing and helping team members with any questions/concerns during launch.
- Member of the Agile Workforce Flex Team assisting both Patient Care Coordinator and Patient Access Specialist departments to facilitate business needs.
- Assist business needs by completing a jobshare with Patient Access Specialist Team.
- Assist the Intake Specialists team by partaking in a jobshare.
- Work with Pharmacy Manager in piloting the Pharmacist Counseling Pilot.
- Work with Business Analysts and Lead Management in creating and testing new phone panel for entire pharmacy.
- Was selected to participate in Work From Home Pilot.
- Work with Program Manager to outline and modify system process flows.
- Assist leadership team in conducting Outbound Calls, working on FedEx Exceptions as well as working on the CSR Task Queue.
- Train new hires with Salesforce/Valet System; serve as Side by Side coach for new hires.
- Created training material for new hires.
- Devised daily Scavenger Hunts for the team during system conversion to SalesForce.
- Receive and sort incoming mail to PAP.
Pharmacy Service Representative I Infertility
CVS Caremark
Mount Prospect, IL
06.2013 - 04.2015
- Piloted and managed Texting Program at CVS Corporation.
- Scheduled, processed and shipped Donor/Recipient orders.
- Assisted patients with scheduling and shipping orders, answering any questions regarding shipment, medications, and insurance coverage (coverage, copays, etc.).
- Verified and reviewed patients’ insurance, communicating with account managers of various insurance plans regarding any claim rejections and escalated issues (Insurance companies, liaisons, clients, PA Resolution Teams, Pricing Coordinating Teams).
- Reviewed and finalized all orders for the fertility department, ensuring all orders are complete, copays collected, and orders are cleared and printed to pack for shipping.
- Assisted supervisor in monitoring calls.
- Interpreted insurance plan benefits, Prior Authorization, Plan Exclusions, Benefit Maximums, Non-Coverage; assisting patients with various options of assisted coverage with any copay cards or self-pay options.
- Assisted with referral status monitoring for benefit investigation.
Pharmacy Technician
Dominick’s
Chicago, IL
08.2010 - 03.2013
- Processed and dispensed prescriptions (physical, faxed, electronic) communicating with insurance companies and doctors’ offices accordingly.
- Input patient, doctor, insurance, and allergy information.
- Maintain pharmacy inventory and files in coordination with manager.
- Assisted patients with questions and concerns via phone and in person.
Education
Associates - Nursing
Oakton Community College
Des Plaines, IL01.2013
Bachelors - Natural Science
Concordia University
River Forest, IL06.2011
Skills
Medical terminology
HIPAA compliance
Professionalism and ethics
Exceptional communication
Insurance verification
Eligibility determination
Customer service
Phone and email etiquette
Multitasking and organization
Certification
Certified Pharmacy Technician
Locations
- North Chicago, North Chicago, IL
- Mount Prospect, Mt. Prospect, IL
- Chicago, Chicago, IL
- Des Plaines, Des Plaines, IL
- River Forest, River Forest, IL
Timeline
Patient Access Specialist I
Abbvie
08.2022 - Current
Patient Care Coordinator I
AbbVie
04.2015 - 08.2022
Pharmacy Service Representative I Infertility
CVS Caremark
06.2013 - 04.2015
Pharmacy Technician
Dominick’s
08.2010 - 03.2013
Associates - Nursing
Oakton Community College
Bachelors - Natural Science
Concordia University