Delivering projects on time and within budget, I excel at initiating and motivating cross-functional teams to achieve desired results. identifying and mitigating risks. Strong focus on tracking progress and driving documentation, I ensure comprehensive project support. Taking full ownership of project scope and manage all phases of the project life-cycle process. Specializing in Regulatory & Compliance projects with potential enterprise-wide impact, I handle mandates implementation. Depending on project scope and complexities.

Acquire a thorough understanding of the manufacturer sponsored program. Receive and effectively route program referrals. Develop contacts within each member pharmacy in order to maintain most current status on referrals. Maintain tracking document and crosscheck to ensure platform/tracking document accuracy. Build a lasting relationship with manufacturer sales representatives by properly communicating and addressing any questions in a timely manner. Actively engage employees, clients, physicians, and pharmacies to proactively solve problems and ensure proper follow up. Provide daily/weekly/monthly updates to manufacturer regarding referral status as needed. Resolve any inquiries from manufacturer sales force via phone or email. Appropriately document all interactions within Asembia’s workflow system. Interface with programmers as needed to address any system difficulties for both manufacturers and internal staff. Communicate with internal contacts, manufacturers, insurance companies, pharmacies and patients to achieve program goals. Effectively train or retrain team members based on feedback. Work collaboratively in a HIPAA compliant manner to ensure all compliance standards are met.. Compliance with the provisions of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, as amended (“HIPAA”)

Responsible for providing high quality client-focused support for customers/pharmacies/physician with order and reorder, benefit eligibility questions and prescription status inquiries; handle inquiries both telephonically and email. Interact with patients, healthcare providers and insurance companies. Provide prompt reliable, and accurate information to customers while maintaining effective communication during conversation by adjusting to the pace and technical level of the patients. Request refill authorization from physicians via fax and phone. Activate/Enroll new accounts into system in a timely manner. Educate patients on benefits, use of plan, formulary, premiums and status of orders, claim or inquires. Maintain a positive and professional demeanor at all times; Achieve individual performance goals for productivity and quality.

RESPONSIBLE FOR ALL ASPECTS OF INTAKE OF INCOMING PRESCRIPTIONS INCLUDING BUT NOT LIMITED TO BENEFIT INVESTIGATION, ACCURATE PRESCRIPTION DATA ENTRY, COORDINATION OF FINANCIAL ASSISTANCE PROGRAMS, COMMUNICATION WITH THE PATIENT INTRODUCING THE PHARMACY AND THE PATIENT MANAGEMENT PROGRAM AND ACTING AS AN ADVOCATE FOR THE PATIENT. SUPPORT AND COMMUNICATE WITH OUTSIDE SALES TEAM ON STATUS OF PRESCRIPTION REFERRALS. SUPPORT PHARMACIST STAFF IN DAILY CLINICAL INTERACTIONS WITH PRESCRIBING PHYSICIANS AND PATIENTS. ANALYZE BILLING TRENDS AND DEVELOP REFILL COMPLIANCE POLICIES AND PROCEDURES TO ENSURE TIMELY SUBMISSION OF CLAIMS TO PAYERS. ASSIST SENIOR LEADERS WITH TROUBLE SHOOTING PATIENT ACCOUNTS AND PROVIDE RESOLUTION FOR DE-ESCALATION. COMPLETE FULL INTAKE FOR NEW PATIENTS BY COLLECTING ALLERGY, PATIENT HISTORY, THERAPY LIST, AND PRESCRIBER TESTING INFORMATION. RESOLVE INSURANCE REJECTIONS AND FAILED CLAIMS BY COMMUNICATING WITH INSURANCE PLANS MANUALLY AND ELECTRONICALLY. MAINTAIN DETAILED SPREADSHEETS OF STATUS OF PRESCRIPTION REFERRALS. Maintain positive relationships with doctor’s office. Act as a Liaison between the pharmacy and doctor’s office.

Completed CVS/Specialty system data migration and assisted with the onboarding of 50k patients as a member of the Field Conversion Team. Manage Multiple Sclerosis and Oncology REMS compliance by ensuring all necessary authorizations are on file and prescriptions contain all information as set forth by manufacturers. Complete full prescription benefit investigation and request all necessary prior authorizations to allow accurate benefit quotes for new patients. Coordinate prescription deliveries to prescribers and patients for therapy compliance. Assist senior leaders with trouble shooting patient accounts and provide resolution for de-escalation. Complete full intake for new patients by collecting allergy, patient history, therapy list, and prescriber testing information. Resolve insurance rejections and failed claims by communicating with insurance plans manually and electronically. Research copay assistance for patients who express financial difficulty in covering expensive specialty therapies.

Processed fax authorizations for physical and occupational therapies. Referenced ICD9 codes to ensure requests were properly processed. Handled initial screening for precertification requests from physicians via incoming fax and correspondence. Assured all clinical notes were accurate and met Horizon Blue Cross standards.