Shamilah Lwanga
Allen,TX
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Specialty Pharmacy Liaison
06.2023 - Current
- Acts as a bridge between specialty pharmacies, patients, and healthcare providers
- Assisted with navigating insurance coverage and financial assistance
- Ensure timely and accurate dispensing of prescribed specialty medications
- Collaborate with specialty pharmacies to verify coverage and authorization
- Provided exceptional customer service to internal and external customers
- Resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
- Independently and effectively resolves complex accounts with minimal supervision
- Handles complex issues where analysis of situations or data requires an in-depth evaluation of variable factors
- Acts independently to determine methods and procedures on new or special assignments
- Performed related duties and special projects as assigned
- Verified transactions and processes comply with organizational and departmental policies and procedures; suggests changes and solutions as appropriate.
Senior Care Coordinator
Caremetx LLC
Bethesda, MD
06.2018 - 06.2023
- Streamlined access to therapies
- Managed regional case load
- Evaluated and analyzed patient insurance benefits.
- Aided physician office staff and patients in completing and submitting all necessary insurance forms and program applications
- Tracked and followed up on prior authorizations and appeal requests
- Contacted physicians’ offices and patients to communicate PA/appeal denials, approvals
- Serves as a patient advocate and enhanced collaborative relationship between payer, HCP, and patient
- Knowledgeable of HIPAA regulations and HIPAA compliant
- Communicated effectively with payors to ensure accuracy and timely benefit investigation
- Communicated with patients what their financial responsibilities will be
- Informed clinical staff at providers office of denials, required authorizations for services
- Met/exceeded established daily case queues and productivity goals
- Managed multiple territories and communicated with multiple therapy access managers
- Accepted inbound calls from providers, patients, specialty pharmacies and assisted accordingly
- Reported all adverse events related to therapy to Drug Safety.
Lab Assistant
CIAN Diagnostics
06.2020 - 01.2021
- Complied with and maintained competency in all laboratory policies pertaining to accessioning, process sample, report packaging, and returning specimens
- Communicates any important information pertaining to testing
- Troubleshooted discrepancies and utilizes exception handling processes
- Performed other duties as assigned
- Completed a demographic check while accessioning and after release of specimen before sending the laboratory
- Verified patient information on requisition with that on specimens, documenting any discrepancies
- Barcoded specimens and aliquoted accurately, maintaining specimen integrity
- Accurately entered the appropriate information into a computer.
Benefits Verification Specialist
AmerisourceBergen
10.2016 - 06.2018
- Gathered and reviewed all patient insurance benefit information
- Researched and resolved and electronic claim denials
- Reported any reimbursement delays to supervisor (e.g
- Claim denials, pricing error, payments, etc.)
- Managed all necessary documentation required to expedite payments
- Processed any necessary insurance/patient correspondence
- Maintained confidentiality in regard to patient accounts
- Exercised judgement within defined standard operating procedures to determined appropriate action
- Completed quality review of work
- Initiated and documented prior authorization process.
Customer Service Representative
Buy Buy Baby
03.2014 - 10.2016
- Assisted and greeted customers
- Managed work area
- Took inbound calls and routed to appropriate party
- Answered customer questions on products
- Collected payments and returns from customers
- Entered customer information in computer daily
- Monitored logbook of vendors
- Filed and maintained customers’ orders records
- Sorted and prepared mail.
Support Specialist
Interprime USA
02.2013 - 08.2014
- Assisted and supported female and male adults with daily activities
- Serve meals
- Served as a companion
- Managed work area
- Dressing and undressing of residents
- Appropriate reporting of changes in residents
- Assisted with toiletries.
Receptionist
Imran Nursing Services
12.2005 - 07.2012
- Answered multiple phone lines
- Routed phone calls to appropriate personnel
- Managed and cleaned work area
- Collected and distributed parcels and other mail
- Coordinate office activities
- Monitored log books for visitors
- Arrange appointments.
Senior Care Coordinator
Caremetx LLC
06.2023
- Coordinated access to therapies
- Managed regional case load
- Collected and reviewed patient insurance benefit information
- Aided physician office staff and patients in completing and submitting all necessary insurance forms and program applications
- Tracked and followed up on prior authorizations and appeal requests
- Contacted physicians’ offices and patients to communicate PA/appeal denials, approvals
- Serves as a patient advocate and enhanced collaborative relationship between payer, HCP, and patient
- Knowledgeable of HIPAA regulations and HIPAA compliant
- Communicated effectively with payors to ensure accuracy and timely benefit investigation
- Communicated with patients what their financial responsibilities will be
- Informed clinical staff at providers office of denials, required authorizations for services
- Met/exceeded established daily case queues and productivity goals
- Managed multiple territories and communicated with multiple therapy access managers
- Accepted inbound calls from providers, patients, specialty pharmacies and assisted accordingly
- Reported all adverse events related to therapy to Drug Safety.
Education
BS-Psychology -
UMUC
01.2019
Automated Logistics Specialist -
United States Quartermaster School
01.2012
Associate degree - General Studies -
Montgomery College - Rockville Campus
01.2011
Skills
- Energetic Self Starter
- Strong communication skills
- Work well independently or on a team
- Highly productive problem solver
- Skilled and Knowledgeable in Automated Logistics
- Strong organizational skills
- Time Management
- Sufficient knowledge of Microsoft Office Suite
- Independent Problem Solver
- Strong Work Ethic
- Adaptability
- Strong verbal and written communications skills
- Strong professionalism and interpersonal skills
- Active listening
- Attention to Detail
- Data Entry
- Self Motivation
- Phone and Email Etiquette
- Reliability
- Task Prioritization
- Customer Service
Core Competences
- Strong organizational skills
- Time Management
- Sufficient knowledge of Microsoft Office Suite
- Independent Problem Solver
- Strong Work Ethic
- Adaptability
- Strong verbal and written communications skills
- Strong professionalism and interpersonal skills
- Active listening
- Attention to Detail
Highlight Of Qualifications
- Army National Guard since 2011-2019
- Received Top Performer Recognition for Annual re-verification 2017
- Energetic Self Starter with strong communication skills, work well independently or on a team
- Highly productive problem solver who rapidly adapts to changing demands
- Skilled and Knowledgeable in Automated Logistics
Volunteer Experience
- Mentor Program for Free State Challenge Academy, 2014, 2015
- Best Buddies: Program for children with disabilities, 2007, 2008
- Greencastle Elementary School Volunteer: Assisted, 2006, 2007
- Project Harvest: Packed food for the needy during, 2006
Certification
- Project Management *in progress*
Timeline
Specialty Pharmacy Liaison
06.2023 - Current
Senior Care Coordinator
Caremetx LLC
06.2023
Lab Assistant
CIAN Diagnostics
06.2020 - 01.2021
Senior Care Coordinator
Caremetx LLC
06.2018 - 06.2023
Benefits Verification Specialist
AmerisourceBergen
10.2016 - 06.2018
Customer Service Representative
Buy Buy Baby
03.2014 - 10.2016
Support Specialist
Interprime USA
02.2013 - 08.2014
Receptionist
Imran Nursing Services
12.2005 - 07.2012
BS-Psychology -
UMUC
Automated Logistics Specialist -
United States Quartermaster School
Associate degree - General Studies -
Montgomery College - Rockville Campus
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