Shawtate Evans
Charlotte,NC
Summary
Proactive and goal-driven HUB/Patient Services expert with a proven track record of effectively spearheading and enhancing external relationships to elevate the provider and patient experience. Acknowledged for streamlining operations and boosting productivity while upholding superior quality benchmarks. Eager to apply my extensive reimbursement expertise and skillset as a valuable contributor to a dynamic organization's triumph.
Overview
11
11
years of professional experience
Work History
Patient Access Manager
Occam Health Services
12.2024 - Current
- Engage with HCPs and their staff virtually using a multi-channel approach to enhance experience, utilizing approved tools, to support and address questions about product coverages and requirements needed for reimbursement.
- Supports the entire reimbursement journey from patient enrollment or initiation, access determination, payer prior authorization processes to appeals/denials requirements
- Educate HCP’s and office staff on available patient assistance programs and explain the importance of their role in facilitating access to therapy for appropriate, eligible patients. This may include training on web-based provider tools
- Serve as payer and pharmacy expert for defined territory/geography and proactively communicate changes to key stakeholders, both internal and external. Coordinate support with other patient service team members or clients where appropriate
- Identify market access trends from local, regional, or national payers in assigned territory/geography, and partner with internal and client teams to enable appropriate patient access and/or support patient pull-through programs
- Maintain and grow knowledge of national, regional, local and account market dynamics including coverage and prior authorization requirements
- Analyze assigned territory utilizing Tableau, excel or other report generators to execute comprehensive territory analysis, facilitating strategic decision making and optimal management of assigned region to identify areas of focus, trends, and monitoring and measuring assigned KPIs
- Work collaboratively to share insights into customer needs, potential barriers, and payer issues/opportunities for product access.
- Provide access insights to client Zone Access Managers (ZAM) and home office functions as required
- Identify key customer insights through effective questioning, critical thinking and problem solving. Analyze and disseminate data and information as appropriate to partners.
- Executes business in accordance with client values to the highest ethical, legal and compliance standards
Operations Supervisor
CareMetx
10.2021 - 12.2024
- Oversaw and managed a team of 30 members, effectively communicating benefit investigation details to ensure the FRM was informed of next steps for patients on prescribed therapy.
- Monitored job performance to ensure timely completion of tasks in alignment with client- specific service level requirements.
- Conducted daily production monitoring to meet team SLAs, productivity goals, and quality control measures.
- Assisted the client's Area Leader in training initiatives for Reimbursement Specialists, ensuring achievement of performance benchmarks.
- Identified, reported, and maintained adverse events (AEs) and product complaints report for the client.
- Ensured accurate tracking and up-to-date information on all phases of the patient's journey for field team alignment and execution of patient next steps.
- Maintained open communication with staff to promptly address trends and resolve issues.
- Proactively identified program issues and proposed solutions to address challenges.
- Assisted in the development of program training documents.
- Selected to serve on a program pilot, analyzing and presenting results utilizing a new technology to confirm patient's benefits and claim details.
Patient Access Specialist
AmerisourceBergen
09.2015 - 10.2021
- Collaborated closely with territory-aligned Field Reimbursement Manager (FRM) to analyze territory trends, track patient status, and enhance provider outreach efforts.
- Successfully resolved escalated issues related to prior authorizations, appeals, and claim denials, demonstrating expertise in payer terminology and reimbursement protocols.
- Provided invaluable assistance to patients in navigating therapy options and comprehending the financial assistance available (e.g., copay, pap, quickstart, and bridge programs).
- Proactively scheduled frequent updates with aligned FRM to ensure smooth progress in the therapy process for patients.
- Thoroughly collected and reviewed patient insurance benefit information in adherence with program standard operating procedures, effectively communicating findings to authorized parties.
- Conducted outbound calls to insurance companies, securing coverage for medication prior to treatment and confirming available buy and bill options.
- Supported physician office staff and patients in completing and submitting essential insurance forms and program applications.
- Efficiently processed all necessary insurance and patient correspondence.
- Proficiently adhered to reporting and documentation procedures, ensuring accurate and comprehensive records of identified adverse events (AEs) and product complaints.
- Conducted regular analysis of reimbursement trends and payer policies, providing insights and recommendations to senior management, resulting in improved reimbursement strategies and increased profitability.
- Collaborated with cross-functional teams including sales, marketing, and legal to develop and implement reimbursement plans for new product launches, ensuring seamless market access and increased revenue.
Interim Team Coordinator
AmerisourceBergen
09.2018 - 02.2019
- Demonstrated effectiveness in training, mentoring, and providing feedback to colleagues
- Facilitated a three-week virtual training for 200-300 associates via Webex
- Possessed a strong understanding of the importance of program operational standards and basic reporting concepts and components (specifically operational policies and processes, program communications, and reporting)
- Provided day-to-day mentoring to team members on performance metrics and program processes, ensuring alignment with program standards
- Trained new and current team members on program standard operating procedures, delivered routine updates, and addressed team members' questions
- Contributed input on individual and group training needs
- Monitored associates' check-in and checkout times, approving timesheets using Fieldglass
- Developed and implemented streamlined processes and procedures, resulting in a 15% reduction in operational costs and improved team efficiency
- Led team meetings and facilitated collaborative problem-solving sessions, resulting in improved teamwork and increased productivity
Trainer- Quality Specilist
WNS Global Services
10.2014 - 09.2015
- Mentored junior team members to enhance their skills and overall performance.
- Prepared and organized employees' timesheets for efficient processing by the payroll department.
- Managed inbound calls from customers, addressing various issues including collections, insurance, claims, payoffs, and billing.
- Ensured comprehensive training of new hires in accordance with Green Tree's desk procedures and policies, offering ongoing support after the two-week training period
- Proactively communicated the latest updates in Customer Service and Collections to the team, fostering a well-informed workforce
- Assessed escalated calls and presented detailed reports to upper management for timely resolution
- Ensured adherence to all FDCPA policies among employees through regular checks and training sessions
- Conducted thorough reviews of Quality scores, providing constructive feedback to enhance employee performance
- Evaluated training effectiveness through the use of assessments and surveys, resulting in a 25% improvement in employee satisfaction with training programs.
Customer Care Specialist
Assurant Specialty Property
12.2013 - 10.2014
- Received inbound calls from homeowners and agents, providing exceptional customer care and support regarding hazard insurance inquiries.
- Implemented necessary updates to policies and disbursements, ensuring accuracy and timeliness.
- Provided expert assistance to homeowners in processing Loss Draft claims resulting from property damage.
- Proactively requested final inspections and facilitated escrow analysis as required or at the homeowner's request, ensuring thorough evaluation and compliance
- Provided exceptional customer service by addressing and resolving customer inquiries and concerns, resulting in an average customer satisfaction rating of 98%
- Managed a high volume of incoming calls and emails, ensuring all customer inquiries were responded to within 24 hours and achieving an 85% first-call resolution rate
- Collaborated with cross-functional teams to identify and implement process improvements, resulting in a 20% reduction in average customer wait time
- Conducted customer satisfaction surveys and analyzed feedback to identify trends and areas for improvement, leading to the implementation of a new training program that improved overall customer satisfaction by 15%.
Education
Hartsville High School
Hartsville06.1994
Skills
- Reimbursement
- Leadership
- Organizational
- Decision-making
- Payer trends
- Financial assistance
Timeline
Patient Access Manager
Occam Health Services
12.2024 - Current
Operations Supervisor
CareMetx
10.2021 - 12.2024
Interim Team Coordinator
AmerisourceBergen
09.2018 - 02.2019
Patient Access Specialist
AmerisourceBergen
09.2015 - 10.2021
Trainer- Quality Specilist
WNS Global Services
10.2014 - 09.2015
Customer Care Specialist
Assurant Specialty Property
12.2013 - 10.2014
Hartsville High School
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