Vincent Madu
Sacramento,CA
Summary
Seasoned professional with several years of experience in customer service, dispute resolution, and compliance, seeking a role as an Appeals Analyst. Expertise in Medicare Part D appeals, chargeback investigations, and maintaining high standards of quality and accuracy. Skilled in providing coverage determination guidance and processing appeals requests, with a strong background in risk mitigation and customer liaison.
Overview
25
25
years of professional experience
Work History
Prior Authorization Specialist
Evernorth Health Services
06.2023 - Current
- Facilitated timely prior authorization requests for pharmacy related services, ensuring compliance with insurance guidelines.
- Streamlined documentation processes to enhance submission accuracy and reduce processing delays.
- Collaborated with healthcare providers to gather necessary information for authorization approvals.
- Analyzed denial trends and implemented corrective actions to improve approval rates.
Prior Authorization Coordinator
Cigna
Baltimore, MD
08.2020 - 06.2023
- Handle inbound faxes and phone inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.
- Provide information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions.
- Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquiries for continuous improvement.
- Work collaboratively with other associates and supervisor to ensure that best practices are shared.
- Other special projects as assigned.
Medicare Part D Appeals Analyst
Cigna HealthSpring
Baltimore, MD
08.2017 - 08.2020
- Facilitate communication with pharmacists, beneficiaries, and healthcare providers to address Medicare Part D appeal inquiries, ensuring adherence to federal regulations and contractual obligations.
- Deliver exceptional customer service through both proactive and receptive engagement, ensuring comprehensive education and precise information dissemination.
- Guide individuals through coverage determination and appeals procedures, attentively addressing questions and concerns to clarify complex processes.
- Process coverage determination and appeal requests with accuracy, contributing to the efficient resolution of customer issues.
Client Service Specialist
Automatic Data Processing (ADP)
Owings Mills, MD
10.2016 - 09.2017
- Managed a broad range of client inquiries, adeptly handling high-call volumes and email correspondence regarding payroll, taxation, and employee benefits.
- Provided comprehensive support on federal, state, and local tax compliance, benefits accruals, and reporting processes, ensuring accurate and timely client service delivery.
Dispute Resolutions/Senior Chargeback Investigator
Global Payments, Inc.
Owings Mills, MD
07.2001 - 10.2016
- Conducted in-depth research and resolution of chargeback disputes, ensuring appropriate measures were taken to minimize financial risk for both the company and its clientele.
- Served as the primary point of contact for customers during the investigation, arbitration, and compliance processes, facilitating the approval and processing of credits and reversals.
- Upheld stringent quality and accuracy benchmarks by resolving complex issues within established deadlines, contributing to the integrity of financial operations.
- Delivered targeted coaching to the investigative team, managed escalated disputes to maintain service excellence, and employed strategic analysis to identify and report abnormal chargeback patterns, mitigating potential losses.
Booking Officer
Public Safety and Correctional Services
Baltimore, MD
01.2009 - 06.2013
- Conducted thorough booking interviews, meticulously recording data in the Automated Booking System to maintain accurate detainee records.
- Assessed arrestees' physical and mental health, ensuring evaluations aligned with established facility protocols for welfare and safety.
- Entered case information into a national database, diligently verifying data accuracy to support reliable reporting and enhance public safety initiatives.
Education
Bachelor of Science - International Studies
Bowie State University
Bowie, MD12-2007
Skills
- Sap, Peachtree, Oracle, Java, Microsoft Word, Excel, Outlook, Analytical thinking, Powerpoint, proficiency with case management software, research proficiency, interpersonal skills, negotiation skills, time management, attention to detail, problem-solving
- Medical appeals handling
- Medical terminology
- Authorizations
- Insurance verification
- Effective communication skills
- Patient referrals
- Data entry
- Medical terminology knowledge
- Physician order verification
- Benefit coverage
- Professionalism and ethics
- Process improvement strategies
- Billing procedures
- Workflow management
Accomplishments
- Achieved positive feedback by completing system checks with accuracy and efficiency.
Timeline
Prior Authorization Specialist
Evernorth Health Services
06.2023 - Current
Prior Authorization Coordinator
Cigna
08.2020 - 06.2023
Medicare Part D Appeals Analyst
Cigna HealthSpring
08.2017 - 08.2020
Client Service Specialist
Automatic Data Processing (ADP)
10.2016 - 09.2017
Booking Officer
Public Safety and Correctional Services
01.2009 - 06.2013
Dispute Resolutions/Senior Chargeback Investigator
Global Payments, Inc.
07.2001 - 10.2016
Bachelor of Science - International Studies
Bowie State University
AI testing on healthcare processing systems
Collaborated in testing an AI system designed to streamline the prior authorization process, enhancing efficiency and reducing processing time thereby reducing the amount of time spent on creating new cases and completing these cases in real time.