Doris Fields, M.P.A. Email & Phone Number

Dearborn, Mi, United States

Greater Detroit Area

Trainer for new employees assigned to the Molina Medicaid Claims Academy. Focuses on state specific processing guidelines for Professional, Outpatient and Inpatient Medicaid claims.

Midwest

Field based Reimbursement Speciatist working with physician offices and hospital accounts to remove obstacles to payment for pharmaceutical drugs and devices. Responsible for a coverage area that included Indiana, Michigan and Pennsylvania.

Bridgewater, Nj

Field based account manager for regional and local managed care plans including Blue Cross Blue Shield, Horizon Blue Cross Blue Shield, Highmark Blue Cross Blue Shield, Humana and Health Care Services Corporation. Evaluated commercial payer coverage guidelines and communicated policy changes and updates to sale team.

Rockville, Md

Managed coverage, coding and payment issues for the medical device division. Overturned claim rejections allowing customers access to physician offices and outpatient services. Analyzed nationl and local medical policy regulations. Provided pricing and reimbursement support for all products including medical devices. Created a comprehensive reimbursement strategy for all marketed brands. Evaluated the application for product specific J-codes.

Acted as the internal Medicare expert for the oncology sales team. Created summaries and determined the implications of policy decisions for Medicare. Managed the Reimbursement and Patient Assistance Program and addressed opportunities in reimbursement case management.

Malvern, Pa

Presented reimbursement updates, coding, and billing and strategy to field sales. Designed tools to develop and support coverage of products for chronic pain. Collaborated with sales reps to identfy and resolved reimbursement issues for key accounts. Conducted presentation focusing on access to reimbursement for implantable devices which resulted in an increase in new physician volume and increased sales for two districts. Developed coding scenarios for inpatient/outpatient place of service which included CPT fee schedule changes, ICD9 codes, and ambulatory payment classification coding updates. Prepared claim reviews to identify and resolve coding and payment issues.

Billerica, Ma

Resolved coverage and payment issues for customers in hospital outpatient, freestanding imaging and physician office settings. Trained sales management to understand ultrasound contrast reimbursement issues including coverage, coding, payment and the structure of payment systems for Medicare, Medicaid and private insurers.

* Educated payer medical and pharmacy staff and advised on formulary inclusion.* Leveraged key relationships to obtain favorable coverage guidelines for cardiovascular and oncology products.* Developed tactical reimbursement plans to improve patient access options.* Coordinated techology assessment process working with the BCBS Technology Evaluation Center.* Coordinated medical society advocacy and facilitated payer/provider forums.

* Developed and interpreted reimbursement, utilization and planning methodologies for professional programs.* Developed reimbursement rates and quantified cost impact utilizing consultants, provider input and data analysis techniques for professional and non hospital providers.* Coordinated programming and distribution of professional participation statistics.* Implemented action plans and strategies to address rent versus purchase of durable medical equipment.* Updated reimbursement sections of provider manuals for outpatient psychiatric care and substance abuse. * Maintained charge data on product and services in order to establish maximum payment levels.* Performed desk audits on completed cost reports to ensure accurate hospital payments.

Master, Public Administration

Bachelor Of Science, Dental Hygiene