Vanessa Powe
Charlotte,NC
Summary
Experienced patient access and support professional with expertise in hub operations and prior authorization processes. Proven track record in pharmaceutical reimbursement and buy and bill strategies. Skilled quality analyst with in-depth knowledge of Medicare, Medicaid, and commercial payer systems.
Overview
20
20
years of professional experience
Work History
Case Manager-Remote
United Biosource Corporation (UBC)
King of Prussia, USA
08.2024 - Current
- Assess the individual needs of the patient to develop an appropriate plan of action that empowers patient and caregiver advocacy utilizing approved resources.
- Educated patients on insurance coverage and therapy access process while assessing needs for patient assistance.
- Acted as primary point of contact for patients and caregivers, providing supplemental education and addressing questions related to therapy access and administration.
- Managed long-term patient relationships by tailoring communication plans to individual needs.
- Provided information on affordability resources.
- Engaged with cross-functional internal teams to facilitate effective project coordination and communication.
- Partner with Patient Advocacy.
- Collaborated with Patient Safety, Pharmacovigilance, and Compliance teams to report adverse events and product complaints efficiently.
- Ensure compliance with all relevant regulations and standards.
Senior Reimbursement Specialist-Remote
United Biosource Corporation (UBC)
King of Prussia, USA
01.2022 - 08.2024
- Conduct benefit investigations, verify insurance benefits for patient and physicians’ offices, and submit and obtain prior authorizations; obtain recertification for cases requiring extended treatment/coverage beyond original approval.
- Monitored outstanding items on each case file to ensure completeness and accurate status determination.
- Educated patients and prescribers on program requirements to enhance understanding and compliance.
- Coordinated product orders, shipments, and therapy initiation between pharmacy and patient.
- Identified and reported events according to REMS requirements for specified medication.
- Recognize adverse events, product quality complaints, potential risk events, and forward information for reporting to manufacturer.
- Collaborated with cross-functional teams to enhance project outcomes.
Infusion Billing Specialist
Arthritis & Osteoporosis Consultants of the Carolinas
Charlotte, USA
07.2020 - 11.2022
- Conducted benefit investigations and verified insurance benefits for patients and physicians' offices to facilitate prior authorizations.
- Assisted patients with coverage barriers by navigating Patient Assistance programs and pharmaceutical copay cards to improve access to medications.
- Managed scheduling of patient appointments to ensure timely access to care.
- Organize shipments and delivery of medications from outside sources.
- Collaborated with cross-functional internal teams to enhance project outcomes.
Overpayment Analyst-Remote
Parallon/HCA
04.2018 - 07.2020
- Researched and resolved overpayment discrepancies and credit balances on hospital charges, ensuring accurate financial records.
- Initiated refunds for identified overpayments and resolved outstanding discrepancies, contributing to improved revenue cycle management.
- Tracked recoupments and processed refunds to ensure timely financial adjustments.
- Reviewed and resolved credit balances, enhancing patient account accuracy and minimizing financial liabilities.
- Addressed patient inquiries regarding account balances to provide clarity and support.
- Investigated returned refund checks from insurance companies to identify and resolve issues.
- Recognized problematic accounts and assessed trends to facilitate appropriate solutions.
Reimbursement Counselor-Remote
AmerisourceBergen/Lash Group
08.2012 - 03.2018
- Resolved reimbursement issues for various payers such as Medicare, Medicaid, and commercial payers.
- Conducted investigations to resolve coverage, claims and coding discrepancies.
- Prepared appeals and monitored outcomes.
- Assisted patients with navigation of pharmaceutical copay assistance foundations to reduce out-of-pocket expenses.
- Advocated for patients by educating them on health insurance benefits, billing, and reimbursement processes to empower informed decision-making.
- Served as liaison and consultant for physicians, hospitals, infusion centers, pharmacies, insurance companies, and sales team to streamline communication and improve service delivery.
- Facilitated communication between internal teams to enhance project execution.
Client Representative
The Outsource Group
02.2011 - 08.2012
- Reconciled patient accounts from charge entry to payment posting to ensure accuracy.
- Researched misallocated or erroneous payments in a timely manner.
- Appealed insurance denials to secure corrected reimbursements.
- Submitted and corrected electronic claims through Emdeon claims editing system for timely claim submission and payment.
- Processed refunds to insurance companies and balanced daily postings for reconciliation.
Insurance Coordinator
AmerisourceBergen - US Bioservices
01.2006 - 12.2010
- Conducted benefit investigations to clarify coverage and identify out-of-pocket expenses for patients.
- Assessed new prescription orders prior to dispensing.
- Established communication as the primary point of contact for new referrals, facilitating specialty drug orders for patients.
- Initiated dialogue between prescribing medical offices and patients to ensure timely dispensing of medication and/or supplies.
- Assisted patients with navigation of pharmaceutical copay assistance foundations to reduce out of pocket expenses.
- Coordinated staffing of professional nurses for home infusion and self-injectable training sessions.
Education
High school diploma - General Education
Olympic High School
North CarolinaFayetteville State University - 35 credits
Fayetteville State University
North CarolinaSkills
- Medical terminology and coding
- Pharmaceutical industry knowledge
- Patient assistance programs
- ICD-10 coding expertise
- Insurance claims management
- Medicare and Medicaid navigation
- Patient access strategies
- Reimbursement processes
- Case management skills
- Insurance verification techniques
- Prior authorization procedures
- Compliance adherence practices
- Cross-functional collaboration
- Communication strategies
- Medical billing proficiency
- Case documentation accuracy
- Problem-solving abilities
- Staff education and training programs
- Care coordination
Timeline
Case Manager-Remote
United Biosource Corporation (UBC)
08.2024 - Current
Senior Reimbursement Specialist-Remote
United Biosource Corporation (UBC)
01.2022 - 08.2024
Infusion Billing Specialist
Arthritis & Osteoporosis Consultants of the Carolinas
07.2020 - 11.2022
Overpayment Analyst-Remote
Parallon/HCA
04.2018 - 07.2020
Reimbursement Counselor-Remote
AmerisourceBergen/Lash Group
08.2012 - 03.2018
Client Representative
The Outsource Group
02.2011 - 08.2012
Insurance Coordinator
AmerisourceBergen - US Bioservices
01.2006 - 12.2010
High school diploma - General Education
Olympic High School
Fayetteville State University - 35 credits
Fayetteville State University
Database Experience
- Salesforce
- CRM
- ADP
- Genesys
- Nextgen
- Microsoft Word
- Microsoft Excel
- Emdeon