April Raines, Pacs, Mba, Dha Email & Phone Number

Atlanta, Ga, Us

Redwood City, Ca, Us

Contribute to and engage in instructional best practice for adult learners in PGU's Undergraduate Health Sciences, Graduate Health Sciences, and Graduate Telehealth Microcredential programs

-Responsible for developing and implementing the Market Access Strategy for sipuleucel-T (Provenge®), Dendreon’s flagship autologous cellular immunotherapy, to ensure an integrated approach to payer customers that delivers optimal access for patients - Support and communicate Market Access strategies in partnership with the Marketing, Government Affairs, and Medical Affairs teams- Facilitate unimpeded access to sipuleucel-T with Commercial payers, managed care organizations, Medicare MACs, state Medicaid, and Advantage plans by driving medical policy coverage initiatives within assigned geography- Develop and execute quarterly payer engagement & business plan to remove payer policy criteria that is inconsistent with FDA label- Demonstrate knowledge of healthcare industry trends, reimbursement, and legislative changes, payor policy trends, coding for all sites of care, coverage, and payment - Proactively monitors and debriefs leadership on local, state, regional, national issues and their potential impact on Market Access strategy, initiatives, and opportunities- Cross-functional collaboration with Government Affairs, Medical Affairs, and Marketing to develop value proposition and other disease state assets for use with external partners and customers

Cambridge, Cambridgeshire, Gb

-Develop, implement, and execute strategic plan to optimize access for patients by communicating value messaging for AstraZeneca’s Oncology (Faslodex, Lynparza, Iressa, Tagrisso, Imfinzi, Calquence, and Lumoxiti) and Infectious Disease products (Synagis)-Collaborate with cross-functional partners (including, but not limited to, Market Access & Hub Services, Regional/National Account Directors, Commercial Business Director, National Sales Director, Medical Affairs teams, Area Business Managers, Field Sales Operations) to support the overall business objectives of the organization-Create & foster relationships with physicians, key health systems economic buyers and third-party payer decision makers-Assist offices with the transition of patients from clinical trials to commercial product-Development and execution of regional business plan with alignment to organizational business strategy and goals -Responsible for educating internal and external stakeholders on changes and impacts of payer criteria on the reimbursement landscape, formulary changes, billing & coding

-reimbursement support for new product launches and new indications -review patient benefit options, prior authorization requirements, and alternative financial assistance programs (including PAPs and Bridge programs)-contributes to the development of new product launch plans-Communication with Sales colleagues to identify prescribing barriers related to reimbursement in assigned area-Manage daily activities that support appropriate patient access to client’s physician-administered products in the provider offices and/or hospital outpatient department- Liaison to other patient assistance and reimbursement support services offered by clients-review patient benefit options, prior authorization requirements, and alternate funding/financial assistance programs-review appropriate billing and coding for products, assist with resolving reimbursement issues, and coordinate with client’s patient support services programs representatives-Educate physician office staff on the use of client’s patient assistance and reimbursement support services, including web-based provider programs, and provide information on relevant reimbursement topics related to client’s products.-Monitor state Medicaid and Medicaid MCO coverage policies and Local Coverage Determinations (LCDs) that affect coverage for client's product -Assist client with understanding local payer coverage trends and participate in sales training related to specialty product reimbursement

Milwaukee, Wisconsin, Us

-facilitated college-level courses in Medical Billing and Coding and Health Information Management programs (curricula includes ICD-9, CPT, and HCPCS coding, HIPAA, Anatomy and Physiology, Medical Terminology, Administrative Medical Assisting, Medical Office Administration/Management, Health Information technology/Management)

-Served as Senior Outpatient Oncology Coding Auditor (reviewed claims for accurate coding of injections, infusions, and E&M services; assigned CPT and ICD-9 codes to patient accounts; queried physicians for clarification of records before assigning and/or while auditing patient records; assisted with medical chart reviw & audit process)-Monitor LMRP reports to ensure claims are reviewed for medical necessity and accurate coding-Screened patients for eligibility for Patient Assistance, Drug Replacement, and Indigent/Charity programs-Maintained familiarity with payer contracts applicable to the facility-Minimized bad debt by ensuring timely follow-up of outstanding claims, resolution of denials, and payer correspondence related to requests for additional information-Provided ongoing training, coaching, and performance management, including annual evaluations to staff members

Nashville, Tn, Us

-Supervision of registration, insurance verification/precertification, financial counseling, and cashiering activities of a team responsible for data integrity ensuring complete and accurate information is entered in an efficient manner-Coordinated responsibilities related to insurance verification and precertification for hospital procedures (inpatient and outpatient)-Ensured timely submission of insurance claims-Monitored staff performance in an effort to meet or exceed departmental POS collection goals, reduced patient wait times, and accuracy of patient information-Provided ongoing training, coaching, and performance management, including annual evaluations to staff members

Us

-Follow-up of Medicaid Patient Accounts for all Hospital-owned physician practices to ensure timely payment and maximize A/R recovery-Evaluated and processed explanation of benefits-Processed and reviewed remittance advice from primary and secondary insurance companies to ensure accurate reimbursement-Drafted appeal letters and provided follow-up to physician offices on progress of appeals

Americus, Ga, Us

Assisted Public Relations Department with coordination of hospital-sponsored activities and distribution of patient surveys

-Retrieved and interpreted medication orders; performed pharmaceutical calculations-Entered medication orders into pharmacy computer system for pharmacist's review-Received and triaged information requests from patients, maintenance of inventory and supplies, including retrieval of discontinued, expired, or recalled medications from stock and patient areas-Primary trainer of new technicians, including preparation of work schedules and setting work priorities-Explained Pharmacy benefits to patients and assisted with completion of claim forms

-Assisted Home Care Administrator with scheduling, payroll, and maintenance of patient medical records-Maintenance of supplies and completion of purchasing requisitions

-Assisted HR Director with screening and interviewing potential candidates for house-sitting and personal care positions-Conducted background checks and verification of references; scheduled drug screens and interviews for job applicants

Doctorate, Healthcare Administration

Bs, Allied Health Sciences

Mba, Healthcare Management