Vanessa Heise

Authorization Department, October 2014 - November 2019, November 2023 - Present

• Comply with patient confidentiality and HIPPA laws. Maintain up to date insurance information by verifying eligibility. Work with insurance companies and primary care providers to obtain prior authorization for home infusion services. Work closely with pharmacy, clinical and sales teams to obtain supporting documentation and orders as needed to secure authorization. Document authorization process and all communications in patient's chart within EPIC platform. Upload all documents into electronic records system.

NCPDP Operations/Claims Processing, May 2021 - November 2023

• Resolve errors in patient accounts within EPIC to ensure claims are correct prior to being sent for billing. Verify insurance eligibility. Resolve authorization errors. Work with billing and collection teams to resolve denied claims ensuring path to payment. Upload appropriate documentation into electronic medical record.

Quality Assurance Department, November 2019 - May 2021

• Maintain accuracy of authorizations by ensuring all HCPC/CPT and ICD 10 codes and quantities are correct through designated audit process. Work with authorization team to provide education and feedback on errors.

Intake/Data Entry Department, June 2012 - October 2014

• Create new patient accounts. Create cases for new and existing patients. Monitor Quick Entry team and workflow on designated days. Test pilot software updates. Created training material for new hires. Admit patients for service after verifying all patient account information is entered accurately within designated time frame. Work escalation queues to resolve potential problems. Verify MD licensure, NPI registry and PECOS certification of doctors to be added to our operating system.

• Open and close store in absence of store manager, including system start ups, cash handling and sales floor preparation.
• Handle vendor and warehouse deliveries.
• Complete product returns, transaction voids, customer refunds, cash deposits to safe.
• Complete daily bookkeeping and cash reports.
• Process inventory claims.
• Maintain accurate on-hand balances and pricing of store inventory on signage and in computer system.
• Verify inventory reports for accuracy.
• Delegate tasks to employees and follow through upon completion.
• Assist customers by answering questions, locating products, and resolving complaints.
• Fill patient prescriptions in Pharmacy as needed. Organized and recovered shelves, put away returns, and cleaned spills and messes to maintain high standards throughout sales floor.