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Renae Simmons
Orlando,FL
Summary
Experienced Patient Access and Reimbursement Specialist with an extensive background working in the pharmaceutical industry. Skilled in Training: Development, Facilitation, and Evaluation, Instructional Design, Leadership and Coaching, Relationship Building and Customer Experience, and Patient Access and Reimbursement.
Overview
13
13
years of professional experience
Work History
Sr Patient Access and Reimbursement Specialist
CVS Health
Orlando, FL
09.2017 - Current
- Deep knowledge in commercial and government reimbursement/access
- Communicated with specialty pharmacies, copay assistance programs and personnel to navigate patient access and reimbursement
- Demonstrating strong problem-solving skills related to complex patient access challenges across payers and specialty pharmacies
- Educated staff on prior authorization requirements, coverage status, and payer appeals requirements, processes, and timelines
- Worked with staff on Oncology, Neurology and Immunology portfolio
- Educated staff on prior authorization requirements, coverage status, payer requirement, processes, and timelines along with denial and appeals
- Condensed complex issues into simple solutions to improve customer experience
- Educated team regarding patient financial help and alternate funding options for uninsured and underinsured.
- Proficient in 'buy and bill', specialty pharmacy supply, including relevant medical and pharmaceutical benefit reimbursement process
- Leveraged expertise and skills to improve competencies of peers
- Experience working with physician practices, navigating patient assistance programs and similar pharmaceutical support programs
- Understand HIPAA rules and regulations related to patient privacy
- Excellent computer skills, including knowledge of Microsoft Office products including Outlook, Excel, Word, and PowerPoint
- Strong written and verbal communication and presentation skills
Medical Billing And Collections Specialist
CVS Health
Orlando, FL
09.2017 - 04.2019
- Audited third party claims associated with dispensing of prescription medication while maintaining supporting chronological notes that detailed action taken to resolve outstanding account balances
- Performed all billing/collection reports, queues, or diversions according to payer and company policy guidelines
- Researched and responds by telephone, via Internet and in writing to insurance companies and governmental payers (VA, TriCare, TriCare4Life,Medicare Part A,B and D) regarding billing issues and problems
- Oversaw submitted claims; monitored unpaid claims, started appeals and resubmitted claims when necessary
- Interpreted payer trends, prepared projects for escalations to ensure timely and accurate reimbursement of claims
- Submitted claims (paper, electronic) to insurance payers for reimbursement
- Resolved insurance problems and patient issues that may have resulted from incorrect or incomplete information, therapy changes and pharmacy or shipping errors
- Provided detailed claim status follow up with patients and payer Contact VA, TriCare and TriCare4Life and other commercial insurers as needed in order to expedite claims processing
- Investigated and determined if billed claim is complete and accurate before filing
- Process Medicare/Medicaid and commercial claims
- Resolved pharmacy questions related to Medicare Part B/D for providers and patients
- Ensured patient confidentiality and safeguarded all medical records
- Performed targeted collections on past due accounts aged over 30 days
- Worked with supervisors to apply customer remittances
- Applied over 200 payments per week
- Produced, distributed and tracked over 800 monthly invoices for insurance business
Senior Resolutions Specialist
CVS Health
Solon, OH
12.2014 - 09.2017
- De-escalated calls that Customer Care Representatives cannot handle
- Work directly with mail order pharmacy to insure members receive prescriptions on time
- Assist Members with pharmacy questions related to Medicare Part B/D
- Enrolled patients with Medicare and Eligibility Department to ensure that Medicare Member correct
- Contact doctors to resolve issues with prescriptions for members
- Follow up on payment disputes and un-applied payments for member’s account for both premiums and prescriptions
- File and follow up on Grievances and Appeals
- Pull calls to coach Customer Care Representatives
- Started and help resolve Prior Authorizations and Coverage Determinations
- Wrote reports to send to management on customer care representatives' coaching
- Increased customer satisfaction by resolving mail order issues
- Worked with Medicare customers to understand needs and provide prescription information
- Managed over 50 escalated calls per day
Customer Care Representative 2
CVS Health
Solon, OH
07.2014 - 12.2014
- Managed high priority,sensitive client–Health First
- Provide telephone support to patients receiving life-sustaining drugs
- Assist Members with pharmacy questions related to Medicare Part D
- Coordinated and processing of new patient medication orders and reorders
- Providing order status on prescriptions
- Processing new or refill prescriptions
- File Grievances and Appeals
- Work on Special projects as assigned
- Responded to customer needs through competent customer service and prompt problem-solving.
Technical Trainer
AT&T/VXI Global Solutions
Akron, OH
09.2011 - 07.2014
- Conducted training for new and current employees and supervisors
- Co-ownership, with operations of trainee performance 30 days after classroom instruction
- Cross-trained and backed up other customer service managers
- Collaborated with leadership to determine technical training needs
- Maintained Human Resources Information System records to monitor completion of new hire paperwork and approved pending changes along new enrollments to benefits
- Conducted new employee orientations specific to Health Insurance plans providing support to all new hires regarding their enrollment
- Compiled IT training and assessment resources based on understanding of technical processes and skills-development needs.
Education
Associate of Science - Radiology
Keiser University
Tallahassee, FL06.2011
Skills
- Medicare Enrollment Part A & B
- Medicare/Medicaid Drug Coverage
- Medicare Claims Sequestration
- AT& T Certified Technical Trainer
- Certified Customer Service Coach
- AT&T Certified Operations Manager Coaching Instructor
- Presentation Skills
Timeline
Sr Patient Access and Reimbursement Specialist
CVS Health
09.2017 - Current
Medical Billing And Collections Specialist
CVS Health
09.2017 - 04.2019
Senior Resolutions Specialist
CVS Health
12.2014 - 09.2017
Customer Care Representative 2
CVS Health
07.2014 - 12.2014
Technical Trainer
AT&T/VXI Global Solutions
09.2011 - 07.2014
Associate of Science - Radiology
Keiser University