Tatiana Egan
Sioux Falls,SD
Summary
A highly motivated employee with a desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. A hardworking employee with customer service, multitasking, and time management abilities. Goal-oriented RCM analyst always assists management with developing updates to operational standards, and team organization. A proactive and personable leader, who prioritizes tasks and approaches issues with an analytical mindset. Bringing years of experience and demonstrated track record of success.
Overview
5
5
years of professional experience
Work History
RCM Analyst
Accredo Specialty Pharmacy
Sioux Falls, SD
04.2022 - Current
- Generate invoices based on contracts, agreements, and other documents received from clients.
- Submit claims to insurance companies, research and resolve denials, billing inconsistencies, and explanations of benefit rejections.
- Reviews and processes customer invoices for accuracy with a focus on Enrollment and Billing.
- Audits accounts and enrollment/billing processes to identify improper changes and identifies areas where efficiency could be improved within the billing department.
- Analyzes data from customer accounts and resolves billing issues with customers.
- Establish key relationships with peers throughout the company to improve workflows and reduce communication bottlenecks.
- Assists with modifications of existing SOPs to resolve outstanding balances.
- Works with team members and leadership to identify and develop process improvements.
- Contact insurance providers to verify insurance information and obtain billing authorization.
- Managed numerous client accounts to track and collect money owed.
- Provide guidance, coaching, and direction to more junior members of the Enrollment / Billing team and train new hires.
Enrollment Billing Senior Representative
Accredo Specialty Pharmacy
Sioux Falls, SD
02.2020 - 04.2022
- Reviewed and processed customer EOBs, credits, and payments accurately.
- Researched discrepancies between customer invoices and payments received.
- Evaluated customer invoices and resolved issues discovered during the invoicing and collection process.
- Assisted customers with inquiries regarding their bills and any raised issues.
- Worked with insurance companies to obtain payments and solve problems.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
- Investigated and resolved issues to maintain billing accuracy.
- Prepared documentation required for collection to obtain payments from the insurance companies.
Claim Biling Analyst
Cigna specialty pharmacy
Sioux Falls, SD
12.2018 - 02.2020
- Led the team of Medical Billing, Medicare, and Copay Assistance technicians.
- Reviewed daily reports for medical and pharmacy billed claims to ensure shipments were sent out with valid authorizations.
- Prepared weekly reports for the billing team and determined their daily workflow.
- Created monthly financial reports and analyzed data for pharmacy management leadership.
- Assisted with the development and reviewing of new billing procedures for the Billing and Accounts Receivable department.
- Ensured training and communication with appropriate teams in regard to system updates.
- Assisted with the enhancement of the extended payment plan process to systematically obtain the first payment at the time of the medication shipment.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
- Entered procedure codes, diagnosis codes, and patient information into billing software to facilitate invoicing and account management.
- Checked claims coding for accuracy with ICD-10 standards.
- Assisted with claim remediation projects for pharmacy and medical claims.
- Analyze and resolve escalated issues involving customer accounts.
- Conducted interviews of potential new hires with hiring supervisor.
- Provided training to new staff members on billing processes and procedures.
Certified Pharmacy Technician
Cigna Specialty Pharmacy
Sioux Falls, SD
09/05/12 - 12.2018
- Processed new orders or refill requests from physicians' offices via telephone, fax, or electronic channels and verified information for completeness and accuracy.
- Created new customer profiles and updated demographics, allergies, and new medications in pharmacy computer systems.
- Managed customer inquiries regarding prescription status or insurance coverage issues for specialty drugs, including Limited Distribution Drugs
- Communicated effectively with doctors and insurance agencies to resolve prescription cost discrepancies.
- Researched and resolved prior authorization issues with third-party payers as needed.
- Coordinated delivery services of specialty medications to patients' homes or other designated locations.
- Provided support to pharmacists in answering questions related to product selection, pricing, and reimbursement.
- Supported customer service in providing accurate and timely responses related to order status, claims issues, or financial assistance.
- Assisted a highly focused group of Clinical Nurses and Pharmacists with providing the best customer care to hemophilia and infusion patients, including obtaining valid authorizations and home health care before shipments of high-dollar drugs.
Pharmacy Technician
Cigna Home Delivery Pharmacy
Sioux Falls, SD
03/01/07 - 09/05/12
- Entered prescription information into computer databases.
- Prepared medications for dispensing by counting, labeling, and verifying doses.
- Teamed with peers, technicians, and pharmacists to prioritize and complete orders.
- Assisted pharmacists with filling prescriptions accurately and efficiently.
- Handled oral and specialty drugs and shipped them to patient's homes or other designated locations.
- Conducted regular physical counts to ensure the accuracy of inventory records, especially of the controlled substance drugs.
- Worked closely with other teams to assist with shipments of escalated issue orders.
- Became Certified Pharmacy Technician.
Education
High School Diploma -
Kilian Community College
Sioux Falls, SD05-1995
Skills
- Risk Assessment
- Customer Communication
- Adaptability and Flexibility
- Attention to Detail
- Task Prioritization
- Analytical Thinking
- Team Collaboration
- Multitasking
- Problem-Solving
- Financial Management
- Relationship Building
- Process Improvement
Languages
Slovak
Native/ Bilingual
Czech
Full Professional
Russian
Limited
Polish
Elementary
References
References available upon request.
Timeline
RCM Analyst
Accredo Specialty Pharmacy
04.2022 - Current
Enrollment Billing Senior Representative
Accredo Specialty Pharmacy
02.2020 - 04.2022
Claim Biling Analyst
Cigna specialty pharmacy
12.2018 - 02.2020
Certified Pharmacy Technician
Cigna Specialty Pharmacy
09/05/12 - 12.2018
Pharmacy Technician
Cigna Home Delivery Pharmacy
03/01/07 - 09/05/12
High School Diploma -
Kilian Community College
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