Vanessa Jimenez
Cherry Hill,NJ
Summary
Accomplished Client Service Analyst with a robust background in reimbursement management and a proven ability to enhance client satisfaction through exceptional service and problem-solving skills. Leveraging expertise in coverage evaluation and complex project management, Excelling in analyzing and optimizing processes to improve efficiency and outcomes. Known for strong analytical capabilities and a commitment to delivering high-quality results.
Overview
17
17
years of professional experience
Work History
Client Service Analyst / Support Associate
Knipper Health
02.2023 - Current
- Support productivity and efficiency for the client programs, while ensuring all work is completed accurately and within the extent of the Statement of Work, client business rules/deadlines, internal Standard Operating Requirements (SOPs) and PDMA Regulations.
- Assist in the maintenance and updating of all client documentation.
- Support creation of Client program documentation and system set up needed in order to ensure systems, financial and details are running and stored correctly.
- Provide internal/external clients with email, fax, and phone support as required by program.
- Monitor and support all inventory tasks and operations. This includes but is not limited to reconciliations, monitoring inventory levels, and tracking back-order situations.
- Monitor and review sales representatives sampling activities and sample transaction data via the Sample Accountability System.
- Review and monitor daily orders, reports and files required by assigned clients.
- Support the coordination of 3rd party field audits for sales representative, and issue program instructions to external PDMA auditors in adherence with client business rules and/or SOP’s if applicable.
- Support daily tasks required including but not limited to data entry/management of forms, troubleshooting, and resolving system issues, and running/sending client reports.
- Report compliance-related issues in a timely manner to the client contact and internal Regulatory and Compliance Department, following the FDA schedule and client business rules.
- Proactively communicate all anticipated program changes and opportunities to the Manager and/or Program lead.
- Support and resolve outstanding Acknowledgement of Content or Signature Verification Letters.
- Support internal Quality Events (QE) and provide necessary and timely follow-up.
Senior Reimbursement Specialist / Case Manager
Conduent
03.2018 - 12.2020
- Contacted insurance for eligibility, benefits, network status and prior authorizations for commercial and government payers.
- Prevented delays and claim denials by correcting information prior to submission.
- Was responsible for ensuring adherence and compliance to copay assistance and patient support program.
- Established relationships with patients, providers, pharmacies, and sales team to manage therapy and data.
- Researched available disease-specific information and maintained subject matter expertise in area of infectious disease, Human Immunodeficiency Virus (HIV).
- Handled complex calls in call-center environment.
- Reported Adverse Events to Pharmacovigilance team and Product Quality Complaints, as required and as per policy in timely manner.
- Completed casework in timely and efficient manner with consistent follow-up as accountable case manager.
- Profound understanding in prescription drug benefit management techniques including formularies, prior authorizations, etc.
- Drug launch experience with breakthrough infusion therapy for multi-drug resistance in HIV patients
- Transitioned over 25 clinical trial patients to commercial drug for newly approved Trogarzo.
- Was responsible for caseload of more than 300 patients.
Outtake Coordinator
Mandell's Clinical Pharmacy
08.2016 - 03.2018
- Communicated with patients and cross-departmentally to coordinate shipping and delivery of medications.
- Trained and mentored new employees on company practices and procedures.
- Maintained up-to-date information of IVF protocols and medications in order to best guide patients.
- Prioritized heavy and varied workload in fast-paced environment.
- Drove workflow improvements by streamlining processes.
- Gathered and organized materials to support operations.
- Gained proficiency in pharmacy program RX30.
- Managed over 75 calls per day.
Pharmacy Technician
Cedeno's Pharmacy
02.2014 - 08.2016
- Assisted pharmacists with inventory, preparation, computer processing, and distribution of medications.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
- Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
- Counted, measured, and compounded medications following standard procedures.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems and locating items.
- Restocked automated medication dispensing equipment.
Certified Pharmacy Technician
St. George's Family Pharmacy
03.2012 - 02.2014
- Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Responsible for obtaining prior and ongoing authorizations for service in timely manner.
- Prepared refills and processed new prescriptions.
- Regularly checked and maintained accurate shelf life of medications.
- Stocked, labeled and inventoried medication to keep accurate records.
- Maintained drug inventory levels by ordering necessary medications and supplies.
Certified Pharmacy Technician
Walgreens
06.2007 - 01.2012
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Completed paperwork, entering prescription and insurance or billing information into patient profiles.
- Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
- Restocked automated medication dispensing equipment.
- Regularly checked and maintained accurate shelf life of medications.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Counted, measured, and compounded medications following standard procedures.
- Gained proficiency in pharmacy program BestRx.
Education
No Degree - Licensed Pharmacy Technician
Walgreens Corporate
Perth Amboy, NJ2008
High School Diploma -
Middlesex County Vocational School Perth Amboy
Perth Amboy, NJ06.2007
Skills
- Eligibility Verification
- Data recording
- Insurance coverage verification
- Documentation abilities
- Collaborative relationships
- Proficient in Salesforce, Microsoft Word, Excel, Outlook, Power Point
- Prior authorization processing
- Excellent administrative abilities
- Data integrity
- Patient contact
- Insurance industry experience
- Account management
- Understanding of medical terms
- Insurance industry experience
- Account management
- Understanding of medical terms
Languages
Spanish
Native or Bilingual
Timeline
Client Service Analyst / Support Associate
Knipper Health
02.2023 - Current
Senior Reimbursement Specialist / Case Manager
Conduent
03.2018 - 12.2020
Outtake Coordinator
Mandell's Clinical Pharmacy
08.2016 - 03.2018
Pharmacy Technician
Cedeno's Pharmacy
02.2014 - 08.2016
Certified Pharmacy Technician
St. George's Family Pharmacy
03.2012 - 02.2014
Certified Pharmacy Technician
Walgreens
06.2007 - 01.2012
No Degree - Licensed Pharmacy Technician
Walgreens Corporate
High School Diploma -
Middlesex County Vocational School Perth Amboy
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