Tamara Claudio
West New York, NEW JERSEY, US,NJ
Summary
Dedicated biologic's coordinator proven track record of success in determining eligibility and resolving complex cases. Works professionally with providers, hubs , specialty pharmacies and patients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting patients' needs.
Overview
16
16
years of professional experience
Work History
Program Coordinator
Hacensack Meridian Health
06.2015 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Proficient with managed care and authorization submission through “Covermymeds” and payor specific portals.
- Responsible for navigating benefits, submission of statements of medical necessity and appropriate medical records for therapy initiations.
- Liaison for all specialty pharmacies, field reimbursement managers and patient service centers.
- Educated patients and providers on the intricacies of coverage, financial assistance and reimbursement.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Developed and maintained productive working relationships with healthcare providers.
- Provides clinical services to Pediatric Endocrinologists by initiating benefit investigations, maintaining prior authorizations, appeals for biologic specialty medications and various endocrine therapeutics.
- Served as case coordinator, assuming responsibility for complex, high-volume assignments and guiding endeavors to successful completion.
- Teamed up with managers and executives to assist in evaluating and improving performance of direct services, contributing to strategic program planning and development.
- Informally mentored new service coordinators, answering questions, offering opportunities to shadow and observe and explaining basic information about company procedures.
Biologic Coordinator
Mount Sinai Hospital
01.2008 - 05.2015
- Verified eligibility and compliance with authorization requirements for service providers.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Teamed up with pharmaceutical case managers , Field reimbursement managers and specialty pharmacies to assist in improving performance for patients and providers.
- Communicated with supervisor regarding issues related to case management, resourcing, service collaboration and development of new resources.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Interviewed applicants and explained scope of different available benefits.
Education
Associate of Arts - Business
Phoenix University
Phoenix, United States06.2017
Skills
- Client Advocacy
- Policy Knowledge
- Data Collection
- Time management abilities
- Task Prioritization
- Relationship Building
- Problem-solving aptitude
- Proficient in Covermymeds
- Staff Training
- Time Management
- Team building
- Performance metrics analysis
- Critical thinking abilities
- Insurance procedures
- Insurance Verification
- Medicare and Medicaid knowledge
- Provider Relations
- Buy and Bill
Affiliations
Advisory board member for major pharmaceutical companies including Eli Lilly, Novo Nordisk, Sandoz and Endo
Pharmaceuticals
Languages
Spanish
Native or Bilingual
Timeline
Program Coordinator
Hacensack Meridian Health
06.2015 - Current
Biologic Coordinator
Mount Sinai Hospital
01.2008 - 05.2015
Associate of Arts - Business
Phoenix University
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