SUMMARY:

• Pursuing Bachelors of information technology student with exposure to performing deskside troubleshooting and phone support for both employees and customers. Well - versed in handling installation and operation of different operating systems including Microsoft Windows, Mac OS and Linux.

PROFESSIONAL EXPERIENCE:

Case Manager/Des ktop Support

• Acts as single point of contact and voice for all providers, patients and product / sales team.
• Serves as a patient advocate and enhances the collaborative relationship between the payer, HCP and patient.
• Manages a regional caseload.
• Coordinates access to therapies, conducts appropriate follow up and facilitates access to appropriate support services.
• Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
• Provide assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications in a timely manner.
• Tracks and follows-up on prior authorization and appeal requests when necessary.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Maintains frequent phone contact with provider representatives, third party customer service representatives and pharmacy staff.
• Reports any reimbursement trends/delays to supervisor.
• Processes any correspondence.
• Provides all necessary documentation required to expedite prior authorization requests including demographic, authorization/referrals, National Provider Identification (NPI) number and referring physicians.
• Coordinates with inter-departmental associates as necessary.
• Communicates effectively with payors to ensure accurate and timely benefit investigations.
• Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercise judgment within defined standard operating procedures to determine appropriate action.
• Typically receives little instruction on day-to-day work, general instructions on new assignments.
• Must be knowledgeable of HIPAA regulations and HIPAA compliant at all times.
• Performs related duties as assigned.
• Desktop support services
• Uses Go-to Assist remote support to assist with technical issues.
• Works on troubleshooting problems with online portal service.
• Manage and monitor portal requests and ticketing system.
• Manage secure messaging and support email mailbox.
• Investigate portal requests for duplicates and errors.

Reimbursement Counselor

Confidential, Rockville MD

• Collects and reviews all patient insurance information needed to complete the billing, collections, appeal, and/or cash processes.
• Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payers. Researches and resolves any electronic claim denials.
• Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
• Independently analyzes, reports, and communicates any reimbursement trends/delays (e.g. billing denials, claim denials, pricing errors, payments, etc.).
• Processes any necessary insurance/patient correspondence.
• Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
• Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
• Provides training and support to inter-departmental associates.
• Independently and effectively resolves advanced accounts with minimal supervision.
• May travel to sites to present program services and further build relationship with sites.
• Maintains confidentiality in regards to patient account status and the financial affairs of clinic/ corporation.
• Communicates effectively to payers and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
• Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions. Networks with internal and external personnel in own area of expertise.
• Typically determines methods and procedures on new assignments.
• Performs related duties and special projects as assigned.

National Certified Pharmacy Technician

Confidential, Bethesda MD

• Typing and filling prescriptions.
• Entering and verifying insurance information and resolving real time claim issues.
• Pharmacy inventory specialist, ordering medication, returns, and inventory management.
• Cashier and Cash Handler
• Greet and assist patients with medication or insurance issues.