Obtaining insurance authorization for surgical and for testing for busy speciality Surgery office. Problem solving insurance and billing issues.

IMS HEALTH, Collegeville, PA Plan Analyst (2007-2012)Assured the accuracy and timeliness of the additions and modification to the data base by inputting from internal and external sources to make sure the date being seen by the client is the most accurate. Maintained assigned plan and supplier to check for any irregularity. Weekly visually monitored data for any negative trends in the monthly and quarterly client information. Researched PBM to see data can be moved to a more granular level.• Provided QC on PBM Links to ensure the links were reflecting the ever changing Pharmacy Industry. Worked closely with IT department and analysts. • Accountable for Shire mapping data including handling question for the monthly deliverable and QC.• Performed Medicare Research –researching the changes to Medicare industry yearly to keep large volume of data current.• Served as Medicaid Lead –Researching the FFS Medicaid and the Managed Medicaid correlation.• Ran and QC’d report for Public Profile Offering - responsibilities included sending out a deliverable to several internal and external clients.

Case Associate (1998-2007)Answered high volume calls for medical pre-certification and contacted hospitals/MDO for medical information, as well as sending notification to hospitals, patients and doctors. Indexed faxes from the Web-Extender which logs incoming faxes from the hospitals/MDO. Codes using ICD-9 (International Classification of Disease 9th Revision) and familiar with CPT (Current Procedural Terminology) that utilizes medical terms. • Verified employer specifications for pre-certification – to ensure proper billing by national insurance companies. • Opened and maintained case files as needed for medical pre-certification and sent appropriate correspondence. • Provided authorizations-Approved procedure based on URAC standards.• Troubleshot complex calls and maintained high level of productivity and quality of work acceptable to the Intracorp standard.Medical Support Specialist (2000-2005)Notified doctor’s offices regarding physician review outcomes, as well as peer to peer review. Scheduled appointments for doctors to express concerns. • Assisted a physician advisor and followed up with to make sure the advisor meets State, Federal, URAC and Intracorp standards. • Investigated and resolved issues between the sales department and client. • Sent verbal and written correspondence to the patient/MDO/Hospital.• Forwarded pre-determinations to physicians and notified insurance companies

Medical Support Specialist (2000-2005)Notified doctor’s offices regarding physician review outcomes, as well as peer to peer review. Scheduled appointments for doctors to express concerns. • Assisted a physician advisor and followed up with to make sure the advisor meets State, Federal, URAC and Intracorp standards. • Investigated and resolved issues between the sales department and client. • Sent verbal and written correspondence to the patient/MDO/Hospital.• Forwarded pre-determinations to physicians and notified insurance companies