Edith Estrada Email & Phone Number

• Obtain and verify complete insurance information, including the prior authorization process, copay assistance and coordination of benefits for infusion therapies. • Obtain and verify insurance eligibility for services provided and document complete information in system • Perform prior authorizations as required by payor source, including procurement of needed documentation by collaborating with physician offices and insurance companies • Collect any clinical information such as lab values, diagnosis codes, etc. • Determine patient's financial responsibilities as stated by insurance • Configure coordination of benefits information on every referral • Ensure assignment of benefits are obtained and on file for Medicare claims • Bill insurance companies for therapies provided • Document all pertinent communication with patient, physician, insurance company as it may relate to collection procedures • Identify and coordinate patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programs • Handle inbound calls from patients, physician offices, and/or insurance companies • Resolve claim rejections for eligibility, coverage, and other issues

Conshohocken, Pa, Us

• Exercised excellent pharmacovigilance procedures and adhered to FDA regulatory compliance.• Managed patient referrals, validated medication orders, and maintained accurate records usinginternal EMR system.• Interacted with patients, clinics, hospitals, and pharmaceutical companies for service requests viavarious benefit programs.• Processed claims and determined patient eligibility for specialty treatments under Medicaid/Medicareand Commercial accounts.• Reviewed patient coverage details based on eligibility and payor contracts.• Identified payor restrictions and reported system issues to management.• Handled prior authorizations and claim adjudication based on payor rules and FDA guidelines.• Provided education to doctors and patients on healthcare coverage and financial responsibility.• Managed accounts for high-value customers and collaborated with major pharmaceutical companies.• Resolved escalations and ensured timely communication.• Facilitated interdepartmental communication for a smooth workflow.• Collaborated cross-departmentally to ensure smooth transitions and provided training on companyprocedures

Orlando, Florida, Us

• Supported physicians and patients by obtaining complete insurance information, including priorauthorization, appeals, when necessary, copay assistance and coordination of benefits for patient’stherapies and referrals• Supplied information on referral process and status updates to patients and health care providers inaccordance with HIPAA rules and guidelines• Facilitated resolutions for denied/rejected claims for Medicaid/Medicare and Commercial payors• Assisted with paper claim denials and appeals for therapies provided• Coordinate benefits, claim billing, and appeals of adjudicated and paper claim denials and determinepatient• financial responsibility as stated by insurance providers• Maintained accurate documentation and demonstrated adaptability in a proactive manner.• Effectively delivered cross-functional support and leadership, overseeing diverse projects acrossmultiple departments beyond standard role responsibilities.• Managed exclusive drug referrals in partnership with pharmaceutical companies• Maintained awareness of pharmacy’s operating procedures and newly FDA-approved medications

Orlando, Florida, Us

• Perform operator functions with inbound/outbound calls from a wide variety of clients.• Schedule delivery of the client’s medication and minimize therapy interruptions.• Collaborate with physicians to ensure that insurance, personal information, and account status is up todate and accurately documented• Discuss cost of service, insurance coverage, and payment options with the patients• Serve as the main point of contact for VIP providers and their patients• Help with training to ensure that new employees are prepared to work independently

• Supply third party verification services to clients to ensure personal records are up to date and correct• Obtain client information by answering telephone calls, interviewing clients, and verifying information• Maintain a competent and personalized client support, taking care to cater to the customer’s needs• Provide marketing support, and quality assurance solutions for multiple contracted industries and their clients• Handle both incoming and outgoing calls to assist customers with initiating, closing, and/cancelling service contracts