Our Team

Gracious Folks with Remarkable Talent

Value-Based Strategies employs some of the most empathetic, engaging, and effective leaders you could ever have the pleasure of encountering.

Beverly Ani

Insurance Coverage and Patient Experience Specialist

Qualifications
Apply formal communications training, digital-technology skills, and 15+ years of hands-on coaching experience to drive continuous improvement in chronic care management (CCM), individualized education planning (IEP), and social-capital development (SCD) programs.

Enhance the technical, financial, and administrative performance of startup ventures, small-to-midsized businesses (SMBs), multinational corporations (MNCs), nonprofit organizations (NPOs), and government agencies in the healthcare, education, and social-service sectors.

Improve case-related outcomes by (1) accelerating speed to diagnosis, therapy, and self-efficacy for individuals in health-related evidence, value, and access (EVA) programs; (2) refining IEPs for students in special education (SPED) programs, gifted and talented education (GATE) programs, and alternative programs for academically advanced students (APAAS); and (3) addressing social determinant of health (SDOHs) for subpopulations facing inequities.

Work History
Reimbursement Specialist; ReimbursementIQ; Garden Grove, CA
2020 – Present

Provide hands-on patient support services to accelerate patient access to medical products, services, and solutions subject to disproportionate health insurance claims denials. Document pharmacy benefits and medical benefits. Perform insurance verifications (IVs) and benefit-eligibility checks. Compile proof-of-value required by third-party payers (TPPs), third-party administrators (TPAs), and self-funded/self-insured employers and unions. Secure prior authorization (PA) and predetermination (PD) decisions. Appeal insurance denials.
Win precedent-setting coverage exceptions.

Improve the performance, outcomes, and impacts of medical products, procedures, and programs on behalf of patients, healthcare professionals (HCPs), and healthcare provider organizations. Anticipate needs and troubleshoot challenges associated with patient engagement, education, activation, adherence, and real-world results (RWRs). Remove impediments to market access. Research and resolve clinical, financial, and administrative challenges posed by public health plans (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA), private health plans (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence Health), and self- funded/self-insured ERISA plans (e.g., Costco, Michelin, Walmart).

Verify the quality of in-network suppliers (e.g., durable medical equipment [DME] companies, home healthcare [HHC] agencies, and pharmacies). Refer patients to preferred suppliers with favorable combinations of geography, customer service, and pricing. Confirm product fulfillment. Assure patient satisfaction. Document patient-reported outcomes (PROs).

Accounts Receivable Specialist; PharmedQuest; Brea, CA 2017 – 2020

Increased company revenue, earnings growth, and competitiveness by verifying accounts receivable (A/R) balances, recovering outstanding balances for pharmacy services, and developing systems for more timely collections.

Verified insurance, double-checked diagnostic codes, managed prior authorizations, secured favorable coverage decisions, maximized reimbursement, and reduced days sales outstanding (DSOs, the time from product/service delivery to receipt of payment).

Protected and enhanced the company brand by coordinating benefits with warmth, professionalism, and speed; referring callers to the right subject matter experts (SMEs); and following up on cases to achieve favorable real-world results.

Special Education Teaching Assistant; Magnolia Science Academy, Santa Ana, CA 2016 – 2017

 Improved academic, social, and behavior performance of students with severe disabilities by (1) studying student records; (2) considering barriers to cognitive, emotional, and intellectual growth; (3) developing individualized education plans (IEPs); (4) measuring student progress; and (5) monitoring individual, program, and school performance using GoalTracker software and analytical method

Teacher; Ace Academy, Cypress, CA 2014 – 2016

Improved student self-efficacy, academic achievements, and test scores by (1) working backwards from school assessment and educational program evaluation metrics to lesson plan design; (2) using motivational interviewing to identify student priorities, interests, and support needs; (3) modeling social skills and sharing stress-management, self-management, and self-directed-learning techniques; (4) teaching reading, writing, and arithmetic; and (5) providing assistance with school assignments and homework.

Media Intern; Horton’s Kids, Washington, DC 2013 – 2014

Assured the sustainability and growth of a nonprofit organization by (1) identifying the priorities of key constituents, (2) organizing fundraising events, (3) drafting press releases, (4) managing social media communications, and (5) engaging online and local communities.

Improved the efficiency and effectiveness of the organization by (1) ensuring staff efforts aligned with organizational strategies, tactics, and operations; (2) reengineering business systems, processes, and standards to streamline administrative functions, and (3) creating reusable templates for content development and syndication.

Volunteer; Dream Girls DMV, Washington, DC 2013 – 2014

Increased self-efficacy in female middle schoolers by (1) compiling information on current events; (2) sharing insights, implications, and imperatives for engaged citizenship; and (3) facilitating discussions of the favorable and unfavorable effects of new developments (e.g., sociodemographic, economic, government-related, technological, industrial, and environmental) on activities of daily living (ADLs); quality of life (QOL); and social determinants of health (SDOHs).

Education
Bachelor of Arts: Journalism, Print; Minor: Political Science; School of Communications, Howard University

Suzanne Lara

Patient Experience and Culturally Competent Care Specialist

Qualifications
Increase customer satisfaction, customer retention, and customer lifetime value as a bilingual (English/Spanish) reimbursement specialist, patient support professional, and customer service representative.

Identify, document, and resolve the clinical, financial, and administrative needs of patients, healthcare professionals (HCPs), and healthcare purchasers (e.g., self-funded employers) in reimbursement helpline (hub-service), durable medical equipment (DME), and physical rehabilitation businesses.

Assist with coding, coverage, reimbursement, billing, claims management, insurance denials, insurance appeals, order entry into order management systems, recordkeeping in clinical practice management (CPM) systems, case management using VoIP call center technologies (e.g., RingCentral), and communication template retrieval and customization using Microsoft Office 365 (e.g., Word, Excel, PowerPoint, Outlook, and Access) within on-premises and cloud-based hosting environments (e.g., Windows Server, Azure, Dropbox, and Egnyte).

Work History
Reimbursement Specialist; ReimbursementIQ; Garden Grove, CA 08/2014 – Present

Enhance the performance of Fortune 100 medical product manufacturers and small-to-midsized businesses (SMBs) by applying knowledge of public payers (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA), private payers (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence Health), and self-insured employers (e.g., Costco, Michelin, Walmart).

Deliver patient support services to improve market access for medical products and healthcare services subject to disproportionate health insurance claims denials. Document pharmacy benefits and medical benefits. Perform insurance verifications (IVs) and benefit-eligibility checks. Compile documents required by third-party payers (TPPs), third-party administrators (TPAs), and ERISA plans. Secure prior authorization (PA) and predetermination (PD) decisions. Appeal insurance denials and win precedent-setting coverage decisions.

Locate and assess the quality of in-network suppliers (e.g., durable medical equipment [DME] companies, pharmacies, and home healthcare [HHC] agencies). Refer patients to preferred suppliers with favorable combinations of geography, customer service, and pricing. Verify product fulfillment. Document patient satisfaction and patient-reported outcomes (PROs). Anticipate needs and troubleshoot challenges to improve patient engagement, education, activation, adherence, and real-world results.

Patient Support and Customer Service Representative; Aero Mobility; Anaheim, CA 01/2010 – 08/2014

Increased company revenue and earnings growth by assisting company sales reps in winning new accounts, expanding existing accounts, and securing high-value word-of-mouth referrals.

Helped patients acquire mobility solutions, minimize out-of-pocket (OOP) costs, and sidestep obstacles to product access. Completed order intakes with extreme accuracy. Verified insurance, double-checked diagnostic codes, managed prior authorizations, secured favorable coverage decisions, maximized reimbursement, and reduced days sales outstanding (DSOs, the time from product sale to payment receipt).

Protected and enhanced the company brand by answering phones with warmth, professionalism, and speed; referring callers to the right subject matter experts (SMEs); and following up with internal professionals, managers, and leaders to learn how to handle an increasing number of incoming calls independently and queue up complex transfers even more efficiently and effectively.

Sales Support and Customer Service Representative; Cair Rehab; Anaheim, CA 01/2008 – 12/2009

Accelerated earnings growth, mitigated risk, and enhanced competitiveness by enabling respiratory patients and recipients of durable medical equipment (DME) to be clinically assessed, advised in self-care, and discharged in a timelier manner.

Improved overall service quality, internal operating efficiencies, and corporate scalability by suggesting ways to improve clinical, financial, and business systems, processes, and standards.

Enabled sales reps to focus on pipeline development, relationship building, and account expansion by taking on selected field reimbursement functions and managing order intakes, insurance verifications, pre-authorizations, coding, billing, and claims troubleshooting.

Education

High School Diploma; Magnolia High School; Anaheim, CA

Yolanda Teabout

Insurance Verification and Prior Authorization Specialist

Qualifications
Accelerate patient access to life-saving care and improve patient experience, patient satisfaction, and patient referrals by serving as a customer service professional, patient support expert, and reimbursement specialist in high-tech, high-touch hub service programs focused on specific disease states, chronic conditions, and clinical interventions.

Facilitate the patient journey and improve patient engagement, patient education, patient activation, patient adherence, and patient-reported outcomes (PROs) by (1) helping patients navigate U.S. healthcare and their health insurance plans; (2) improving patient health literacy through plain language and culturally competent communications; and (3) making patient referrals to self-care, healthcare, and community care resources including www.211.org, www.findhelp.org, and www.benefits.gov.

Broaden market access for medical products, healthcare services, and digital-health solutions that have been subject to unwarranted health insurance claims denials—and improve the revenue, earnings growth and competitiveness of Fortune 500 biopharmaceutical companies, medical device manufacturers, and healthcare provider organizations.

Work History
Reimbursement Specialist; ReimbursementIQ; Garden Grove, CA 09/2021 – Present

Support the success of evidence, value, and access (EVA) programs that facilitate favorable coding, coverage, and contracting decisions from public payers (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA), private payers (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence Health), and self-insured employers (e.g., Costco, Michelin, Walmart).

Use call center platforms to manage incoming and outgoing communications across a broad range of healthcare stakeholders. Retrieve and customize templates from on-premises and cloud-based hosting environments (e.g., Windows Server, Azure, Dropbox, and Egnyte). Create documents and update databases using Microsoft Office 365 applications like Word, Excel, PowerPoint, Outlook, and Access. Assist with patient intakes. Document pharmacy benefits and medical benefits. Perform insurance verifications (IVs). Conduct benefit-eligibility checks. Compile prescription information, medical records, letters of medical necessity (LMNs), step therapy plans, and other documents required by third-party payers (TPPs), third-party administrators (TPAs), and self-funded ERISA plans. Secure prior authorization (PA) and predetermination (PD) decisions. Compile information to support appeals of coverage denials. Prepare patients to win precedent-setting coverage exceptions.

Apply knowledge of ICD-10 diagnostic codes, CPT/HCPCS Level I procedure codes, HCPCS Level II supply codes, medical terminology, medical records, medical billing, insurance claims management, denial management, and collections in accepting cases from or handing off cases to external parties. Locate and assess the quality of in-network suppliers including durable medical equipment (DME) companies, retail pharmacies, and home healthcare (HHC) agencies. Refer patients to preferred suppliers with preferred locations, customer service practices, and product pricing. Confirm product fulfillment. Assess patient satisfaction and document patient-reported outcomes (PROs).

Participate in weekly and ad-hoc team meetings. Review outlier events such as unexpected successes (e.g., rare coverage exceptions) and unexpected failures (e.g., patient complaints). Draw lessons from outlier events to support continuous improvement of business teams, business systems, business processes, business standards, and business results. Notify information technology (IT) specialists of critical IT and telecom problems associated with on-premises, cloud-based, and hybrid systems. Assist with IT/Telecom troubleshooting. Define end-user requirements and assist business, technology, and design experts with program enhancements, database upgrades, and business process reengineering (BPR) projects.

Program Specialist; Randstad USA for Covance (now Labcorp Drug Development); Durham, NC 09/2019 – 03/2020

Enabled patients to gain rapid access to medically necessary clinical interventions. Managing incoming calls. Performed patient intakes. Completed insurance verifications (IVs) and eligibility checks to determine whether prescribed therapies and scheduled procedures were eligible for insurance coverage and reimbursement under pharmacy benefits or medical benefits. Managed prior authorization and predetermination requests. Investigated alternative sources of insurance coverage. Searched for financial subsidies for care not covered by health plans. Escalated cases as warranted. Processed patient applications of various complexities to determine patient eligibility. Placed follow-up calls and responded to inquiries from patients, healthcare professionals (HCPs), payers, etc. Documented call, case, and care details in corporate tracking systems. Assisted with other coding, coverage, reimbursement, billing, claims management, denial management, insurance appeals, clinical practice management (CPM), case management, and care management projects, as requested.

Reimbursement Specialist III; Aerotek Recruiting and Staffing / TrialCard; Morrisville, NC 12/2018 – 08/2019

Optimized patient access to medications and healthcare procedures. Reviewed patient case notes. Contacted public or private insurance companies to obtain benefit information. Followed preauthorization and predetermination guidelines. Determined whether healthcare interventions were covered under health plans. Reviewed summary plan descriptions (SPDs). Confirmed individual deductibles, family deductibles, copay requirements, coinsurance, out-of-pocket (OOP) maximums, and policy limits. Obtained national provider identifiers (NPIs). Determined provider network status. Sent verifications of benefits to providers. Reviewed explanation of benefits (EOB) documents with patients. Followed up on claims and denials. Coordinated with patients, providers, and payers on appeals. Customer Service Representative; District of Columbia Local Government; Washington, DC 10/2016 – 03/2017

Managed inbound calls from District of Columbia residents. Assisted callers with enrollment in health insurance plans. Explained the
Affordable Care Act (ACA) and summary plan descriptions (SPDs) following scripts, standard operating procedures (SOPs), and quality assurance (QA) guides. Educated callers about premium tax credits and other government benefits. Applied customer service skills and overarching knowledge of U.S. healthcare to manage outlier events; help callers gain access to coverage; and help caller balance healthcare access, quality, and costs.

Workforce Analyst and Prior Authorization Specialist; Blue Cross and Blue Shield of North Carolina; Chapel Hill, NC 11/2014 – 08/2016

Took inbound calls from patients, healthcare professionals (HCPs), and healthcare provider organizations regarding insurance policies, insurance coverage, and prior authorization (PA) requirements. Prepared prior authorization (PA) cases for review. Advised callers on authorization status. Sent authorization letters and denial letters. Addressed other health plan questions raised by insurance beneficiaries using customer service management (CSM) skills, knowledge management systems (KMSs), summary plan descriptions (SPDs), etc. Trained, scheduled, and managed call center talent. Tracked training, attendance, and performance. Coordinated with operations, human resources, and leadership personnel to support continuous improvement of the call center. Supported large-group enrollment processes. Produced, distributed, and archived daily reports utilizing MS Office applications, including MS Excel. Uploaded mission-critical reports to SharePoint.

Education
High School Diploma; Randallstown High School; Randallstown, MD

Kendria Matlock

Insurance Verification and Prior Authorization Specialist

Qualifications
Paralegal professional with analytic, strategic, and hands-on support experience related to (1) the history and trajectory of U.S. healthcare, the U.S. Department of Health and Human Services (HHS), key HHS agencies (e.g., Food and Drug Administration [FDA], Centers for Medicare and Medicaid Services [CMS], and Agency for Healthcare Research and Quality [AHRQ]), the Social Security Administration (SSA),
and the U.S. Department of Agriculture (USDA); (2) public payers (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA); (3) private payers (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence Health); (4) self-insured employers (e.g., Costco, Michelin, Walmart); (5) biopharma companies, medical device manufacturers, and digital-health innovators; (6) group purchasing organizations (GPO), wholesalers, distributors, suppliers, healthcare provider organizations, and healthcare professionals (HCPs); and (7) insured, underinsured, and uninsured patients.

Patient support professional, insurance reimbursement specialist, and customer service representative, skilled in (1) supporting evidence, value, and access (EVA) programs such as high-tech, high-touch hub-service programs focused on specific disease states, chronic conditions, and clinical interventions; (2) broadening market access for medical products, healthcare services, and digital-health solutions that have been subject to unwarranted health insurance claims denials; and (3) improving the revenue, earnings growth and competitiveness of Fortune 500 biopharmaceutical companies, medical device manufacturers, and healthcare provider organizations.

Hands-on coverage, reimbursement, and appeals expert able to build the case for accelerated patient access to medically necessary healthcare products, services, and solutions—using patient informed consents (e.g., HIPAA-HITECH authorizations to share protected health information [PHI]), pharmacy and medical benefit specifics, ICD-10 diagnostic codes, CPT/HCPCS I procedure codes, HCPCS II supply codes, NDCs biopharmaceutical identifiers, prescriptions, medical histories, letters of medical necessity (LMNs), and step therapy plans—on behalf of patients, guardians, healthcare professionals (HCPs), primary care practices (PCPs), multi-specialty medical groups (MSMGs), and clinical centers of excellence (COEs).

Work History
Reimbursement Specialist; ReimbursementIQ; Garden Grove, CA 09/2021 – Present

Use HIPAA-HITECH-compliant call center and hub-service platforms to manage incoming and outgoing communications across a broad range of healthcare stakeholders. Assist with patient intakes. Document pharmacy benefits and medical benefits. Perform insurance verifications (IVs). Conduct benefit-eligibility checks. Compile documents required by third-party payers (TPPs), third-party administrators (TPAs), and self-funded ERISA plans. Secure prior authorization (PA) and predetermination (PD) decisions. Help patients and healthcare professionals (HCPs) compile information to support appeals of coverage denials. Prepare patients and HCPs to win precedent-setting coverage exceptions.

Help patients navigate U.S. healthcare and their pharmacy benefit plans and medical benefit plans. Improve patient health literacy through plain language and culturally competent communications. Refer patients to self-care, healthcare, and community care resources including www.211.org, www.findhelp.org, and www.benefits.gov. Locate and assess the quality of in-network suppliers including durable medical equipment (DME) companies, retail pharmacies, and home healthcare (HHC) agencies. Refer patients to preferred suppliers with preferred locations, customer service practices, and product pricing. Confirm product fulfillment. Assess, troubleshoot, and improved patient engagement, patient education, patient activation, patient adherence, and patient-reported outcomes (PROs).

Create original documents and update complex databases using Adobe Acrobat and Microsoft Office 365 applications like Word, Excel,PowerPoint, Outlook, and Access. Retrieve and customize templates from on-premises and cloud-based hosting environments (e.g., Windows Server, Azure, Dropbox, and Egnyte). Attend team meetings. Review outlier events—such as unexpected successes (e.g., rare coverage exceptions) and unexpected failures (e.g., patient complaints). Share knowledge, skills, and experience in quality assurance, business process reengineering (BPR), and healthcare improvement initiatives to apply lessons learned and enhance the performance, outcomes, and impacts of life-saving healthcare policies, programs, projects, processes, and products.

Case Manager; Covance (now Labcorp Drug Development); Durham, NC 09/2019 – 03/2020

Assisted patients with copay program, patient assistance program (PAP), and related applications. Managed incoming calls and performed patient intakes. Determined patient eligibility. Interviewed patients and providers around adverse events, documented specifics, and managed mandatory reporting. Helped care coordinators accelerate patient access to medically necessary clinical interventions.

Completed insurance verifications (IVs) and performed benefit-eligibility checks. Evaluated policy language in pharmacy benefit plans and medical benefit plans. Considered whether prescribed therapies and scheduled procedures were eligible for insurance coverage and reimbursement. Pursued prior authorization and predetermination decisions.

Investigated alternative sources of insurance coverage. Searched for financial subsidies for underinsured patients and excluded interventions. Escalated outlier cases. Placed follow-up calls and responded to inquiries from patients, healthcare professionals (HCPs), and others. Entered data into corporate tracking systems. Supported mission-critical projects related to coding, coverage, reimbursement, billing, claims management, denial management, insurance appeals, clinical practice management (CPM), case management, and care management.

Support Coordinator; TrialCard; Morrisville, NC 01/2019 – 09/2019

Assisted patients in completing complex applications for financial assistance in support of medically necessary medical products, clinical procedures, and healthcare treatment plans. Helped case managers, care coordinators, and clinicians obtain prior authorizations, predeterminations, and coverage exceptions. Verified and explained benefits on behalf of patients, healthcare professionals (HCPs), and healthcare provider organizations (HPOs). Documented, reported, and assisted in troubleshooting adverse events.

Reimbursement Care Manager; TrialCard; Morrisville, NC 07/2018 – 01/2019

Studied biological products to understand their FDA-approved indications, off-label uses, and routes of administration. Reviewed formulary-related language to determine whether and when biologics were covered and reimbursed. Contacted indemnity insurers and managed care organizations (MCOs) to make the case for coverage and reimbursement.

Advocated for evidence-based medicine (EBM) using health economics and outcomes research (HEOR) information including cost-minimization, cost-benefit, cost-effectiveness, and cost-utility studies. Compiled proof of value (POV).

Recommended value-based coverage (VBC) and outcomes-based compensation (OBC) decisions. Supplemented peer-reviewed literature with real-world data (RWD) and real-world evidence (RWE). Escalated cases to denial management teams and supported high-level appeal strategies.

Medical Billing Specialist; PFS Group; Morrisville, NC 08/2017 – 06/2018

Performed research on inpatient and outpatient health insurance claims to secure coverage, maximize reimbursement, reverse denials, set precedents, and reduce days sales outstanding (DSO, the time between delivery of a healthcare product, service, or solution and receipt of payment for that healthcare intervention).

Compiled supporting documentation from patients, healthcare professionals (HCPs), and healthcare provider organizations (HPOs) to build the case for coverage using coverage standards and precedents relevant to public, private, and ERISA plans.

Documented case status, managed case progress, reported case outcomes to clients, studied outlier case results, and contributed to corporate continuous improvement.

Authorization Specialist, Team Leader, and Unit Manager; Carolina Outreach; Durham, NC 08/2016 – 08/2017

Served as team leader and then managed a fast-paced special needs program (SNP) with 15 clinicians and administrative personnel.

Designed, developed, and deployed efficient and effective systems for case management, insurance authorization, and denial management—to support special needs patients, medical specialists, and centers of excellence (COEs).

Enrolled special needs clients in state insurance programs to accelerate access to pharmacy benefits and medical benefits. Advocated for enhanced benefits on behalf of clients with extraordinary needs. Created systems for submitted evidence-based appeals to reverse insurance denials and win coverage exceptions from indemnity insurers and managed care organizations (MCOs).

Sr. Legal Clerk; UnitedHealthcare; Morrisville, NC 09/2014 – 08/2016

Provided a broad range of HIPAA-compliant and HITECH-compliant legal research, analysis, and reporting functions to help UHC build the case for insurance policy language, unfavorable coverage determinations for medically unnecessary care, and evidence-based coverage denials.

Prepared cases for court presentation by (1) compiling pharmacy benefit and medical benefit information; (2) creating timelines for patient medical histories, episodes of care (EOC), and clinical encounters; and (3) categorizing evidence supporting or missing from prior authorization, predetermination, and appeal processes.

Responded to subpoenas, authorizations, and other legal matters in support of the corporate legal team—and efficiently and effectively performed highly varied, mission-critical tasks with minimal oversight.

Claim Processor; UnitedHealthcare; Morrisville, NC 09/2013 – 09/2014

Managed initial, rework, and outlier processing of high-value health insurance claims. Research insurance beneficiary (member) medical histories; episodes of care; clinical encounters; insurance plans and policy language; coding, coverage, and reimbursement guidelines; public payer contracting language; provider-related contracting language, etc.

Identified and adjusted medical claims that were processed incorrectly. Researched and rectified overpayments. Confirmed eligibility and managed refunds. Updated member records.

Claim Processor; QBE Financial Partners; Morrisville, NC 02/2013 – 09/2013

Assisted financial-service clients with claim procedures. Processed claim document. Requested release of claim funds. Audited bank information. Managed corrective action. Maintained clean claim records and account records.

Customer Care Agent; Humana; Cary, NC 09/2007 – 02/2013

Answered 100 to 175 inbound calls per day in supporting a Medicare Part D pharmacy benefit program.

Educated patients on critical health insurance topics including the U.S. Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), Original Medicare (aka Indemnity Medicare or Medicare Fee-for-Service [FFS]), Medicare Advantage (aka Medicare Managed Care or Medicare HMO) programs, Dual Eligibility (Medicare and Medicaid), Special Needs Programs (SNPs), and other critical topics.

Ran plan comparisons between Medicare FFS and Medicare Advantage.

Tracked drug formulary changes and advised patients on modifications that could affect their therapeutic treatment plans and drug choices.

Deescalated crises with mission-critical implications. Resolved high-sensitivity patient-related issues within tight timeframes.

Explained plan benefits, resolved claim disputes, and enacted pharmacy overrides. Assisted with pharmacy benefit and medical benefit requests and general troubleshooting in accordance with plan guidelines and customer service guidelines. Processed insurance premium payments. Resolved billing and collections inquires.

Education
Associate of Arts and Sciences (AAS) Degree: Paralegal Studies; Motte College; Raleigh, NC

Charlene Carder

Insurance Verification and Prior Authorization Specialist

Qualifications

Employee benefits professional with more than 10 years of experience analyzing, managing, and improving Total Rewards, employee benefit packages, and employee/retiree support services for enterprises as large as the City of Anaheim in California. First-rate capabilities expanding benefits and reducing costs through careful review, evaluation, and troubleshooting of contracts, premiums, and transaction records associated with life, health, dental, vision, and other insurance policies.

Health insurance coding, coverage, and reimbursement expert with broad and deep knowledge of (1) public payers (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA); (2) private payers (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence Health); (3) self-insured employers (e.g., Costco, Michelin, Walmart); (4) biopharmaceutical, medical device, and digital-health companies; (4) group purchasing organizations (GPO), wholesalers, distributors, suppliers, healthcare provider organizations, and healthcare professionals (HCPs); and (5) insured, underinsured, and uninsured patients.

Patient support professional with a track record of success (1) supporting high-tech, high-touch hub-service call centers and other evidence, value, and access (EVA) programs; (2) broadening market access for medical products, healthcare services, and digital-health solutions challenged by unwarranted health insurance claims denials; and (3) improving the revenue, earnings growth and competitiveness of Fortune 500 biopharmaceutical companies, medical device manufacturers, and healthcare provider organizations across diverse disease states, chronic conditions, and clinical interventions.

Work History
Reimbursement Specialist; ReimbursementIQ; Garden Grove, CA 09/2021 – Present

Manage incoming and outgoing communications with multiple healthcare stakeholders using HIPAA-HITECH-compliant call center and hub-service platforms. Assure quality patient intakes. Confirm pharmacy benefits and medical benefits. Perform insurance verifications (IVs) and benefit-eligibility checks. Secure documents required by third-party payers (TPPs), third-party administrators (TPAs), and self-funded ERISA plans. Manage prior authorization (PA) and predetermination (PD) requests. Help patients and healthcare professionals (HCPs) compile information to appeal coverage denials. Educate patients, guardians, healthcare professionals (HCPs), primary care practices (PCPs), multi-specialty medical groups (MSMGs), and clinical centers of excellence (COEs) in submitting evidence-based coverage-exception requests.

Accelerate patient access to medically necessary healthcare products, services, and solutions. Confirm receipt of informed consents including HIPAA-HITECH authorizations to share protected health information (PHI). Research insurance policy language in pharmacy benefit plans and medical benefit plans. Ensure alignment between prescriptions or treatment plans and ICD-10 diagnostic codes, CPT/HCPCS I procedure codes, HCPCS II supply codes, NDCs biopharmaceutical identifiers, medical histories, letters of medical necessity (LMNs), and step therapy guidelines.

Locate and assess the quality of in-network suppliers including durable medical equipment (DME) companies, online and bricks-and-mortar retail pharmacies, and home healthcare (HHC) agencies. Refer patients to preferred suppliers with convenient locations, superior customer service, and favorable product pricing. Confirm product fulfillment.

Help patients fill gaps in their pharmacy benefits and medical benefits—and navigate other aspects of the U.S. healthcare system. Improve patient health literacy and enhance health equity through plain language and culturally competent communications. Refer patients to important self-care, healthcare, and community care resources including www.211.org, www.findhelp.org, and www.benefits.gov. Assess, troubleshoot, and improved patient engagement, patient education, patient activation, patient adherence, and patient-reported outcomes (PROs).

Create original documents and update case records using Adobe Acrobat and Microsoft Office 365 applications like Word, Excel, PowerPoint, Outlook, and Access. Download templates from on-premises and cloud-based hosting environments (e.g., Windows Server, Azure, Dropbox, and Egnyte) and customize content to achieve specific patient, healthcare professional (HCP), and payer endpoints.

Participate in team meetings and provide insight into outlier events such as unexpected successes (e.g., rare coverage exceptions) and unexpected failures (e.g., patient job loss). Apply lessons learned to improve healthcare policies, programs, projects, processes, and products.

Benefits Specialist; City of Anaheim; Anaheim, CA 01/2007 – 09/2021

Audit accounts; oversee mission-critical aspects of the Total Rewards, employee benefits, and insurance programs for City employees and retirees; and ensure smooth operations during open enrollment periods. Recalculate premiums, employer-employee cost burdens, and financials associated with life circumstances, benefit selections, and related factors. Serve as a liaison between employees, retirees, and benefit vendors (e.g., health and dental plans).

Support employee acquisition, satisfaction, and retention. Support a high-volume call center. Answer benefit questions and troubleshoot benefit challenges associated with job candidates, employees, and retirees. Assist retirees in transitioning into retirement, understanding Medicare, and coordinating benefits. Enter benefit-related information into databases. Manage high-priority, benefit-related projects.

Add new hires; update life circumstances (e.g., suspensions, terminations, moves, marriages, name changes, children, divorces, medical leaves, disabilities, deaths); and maintain complete, accurate, and precise employee benefit information in the AMS system. Prepare exit forms for separating employees, conduct exit interviews, and provide evidence-based feedback to human resource managers and other authorized parties.

Lead Customer Service Representative; UnitedHealthcare; Cypress, CA 01/2000 – 12/2005

Managed a high-volume of incoming calls from Secure Horizon and PacifiCare members and preferred providers regarding insurance-related challenges. Shared benefit information.

Requested network-related and claims-related information from healthcare professionals (HCPs) and clinical practice staff members.
Updated member records and provider records.

Reviewed insurance claims, confirmed proper coding, and forwarded claims for payment.

Billing Lead; Westcliff Medical Laboratories; Garden Grove, CA 04/1997 – 08/2000

Supervised a team of nine (9) coding, billing, and claims management professionals in a diagnostic testing laboratory.

Managed inquiries from patients and providers regarding insurance benefits, laboratory services, and reimbursement issues.

Contacted providers to secure correct ICD-9 diagnosis codes and CPT procedure codes.

Input call, client, and case information into computer systems.

Education

Associate of Arts Programs, Southern California Community Colleges

High School Diploma, Orange County High Schools

Mike Dungo

Medical Records and Insurance Documentation Specialist

Qualifications
Health insurance, insurance coding, and insurance documentation specialist with knowledge, skills, and experience in (1) ICD-10-CM, CPT/HCPCS Level I, HCPCS Level II, NDC, and other codes used in CMS 1500 claim forms, electronic health record (EHR) systems, and practice management systems (PMSs, like AdvancedMD); (2) securing prescription information, letters of medical necessity (LMNs), and step therapy plans; and (3) handling patient protected health information (PHI) while assuring ISO 27001, NIST, and HIPAA-HITECH compliance.

Call center, data entry, and administrative support specialist with 10+ years of experience collecting informed consent forms from patients, securing national provider identifier (NPI) numbers from healthcare professionals (HCPs), verifying diagnostic codes, uploading prescription and medical history information, documenting insurance benefits, performing insurance verifications (IVs), conducting benefit-eligibility checks, securing statements of medical necessity (SMNs), confirming treatment plans, obtaining prior authorizations (PAs) and predeterminations (PD), tracking insurance coverage policies, escalating insurance denials, and advocating for coverage exceptions.

Quality control professional trusted to collect and maintain current information on (1) public payers (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA); (2) private payers (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence Health); (3) fully funded, premium-paying health plan sponsors; (4) self-funded/self-insured healthcare purchasers (e.g., Costco, Michelin, Walmart); and (5) social-service programs (e.g., www.211.org, www.findhelp.org, and www.benefits.gov).

Work History
Documentation and Patient Support Specialist; ReimbursementIQ; Garden Grove, CA 10/2018 – Present

Collect insurance-related information from health plan beneficiaries (e.g., patients and guardians), healthcare professionals (HCPs), primary care practices (PCPs), multi-specialty medical groups (MSMGs), clinical centers of excellence (COEs), third-party payers (TPPs), third-party administrators (TPAs), fully insured health plan sponsors (e.g., premium-paying employers), self-funded healthcare purchasers (e.g., self-insured employers and unions), etc.

Compile case-specific clinical, financial, and administrative data and documents within Azure, Egnyte, and other cloud-based hosting environments. Communicate with a broad range of healthcare stakeholders using version-controlled templates and Office 365 applications like Word, Excel, PowerPoint, Outlook, and Access.

Comply with legal, regulatory, and professional standards.

Make recommendations to business professionals, managers, and leaders on ways to reengineer business systems, processes, and performance standards to improve enterprise revenue, earnings growth, and competitiveness—all while optimizing the economic, clinical, and humanistic outcomes (ECHOs) of medical products, services, and solutions.

Authorization Coordinator; The Oncology Institute; Cerritos, CA 06/2018 to 10/2018

Engage, educate, and empower patients.
Compile insurance information related to pharmacy benefits and medical benefits. Run insurance verifications. Complete benefit eligibility determinations. Secure letters of medical necessity (LMNs) and other information required by third-party payers (TPPs) and third-party administrators (TPAs).

Secure prior authorizations and predeterminations in support of treatment plans.
Follow up with independent physician associations (IPAs) to resolve pending authorizations.
Schedule care, notify patients, and minimize no shows.

Transaction and Data Processor; Conduent, Inc.; Garden Grove, CA 11/2009 to 06/2018

Use software applications to queue up and process transactions. Compile and enter data following standard operating procedures (SOPs). Ensure claims are complete, accurate, and precise to accelerate payment processing. Call attention to outlier events to ensure professionals, managers, and leaders can rapidly correct errors, reengineer business systems, and improve business performance.

Education
Certificate: Medical Billing and Coding (MBC); American Career College; Anaheim, CA

Grant Garcia-Rojas

Medical Records and Insurance Documentation Specialist

Qualifications
Insurance benefits, coding, and documentation specialist skilled in building the case for insurance coding, coverage, and contracts by applying storytelling, scriptwriting, and film treatment skills—e.g., communicating the hero’s journey—in interacting with (1) public payers (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA); (2) private payers (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence); (3) fully funded, premium-paying health plan sponsors; (4) self-funded/self-insured healthcare purchasers (e.g., Costco, Michelin, Walmart); and (5) social-service programs (e.g., www.211.org, www.findhelp.org, and www.benefits.gov).
Tech-savvy content development, content management, and content syndication expert with hands-on experience creating, nurturing, and growing social-media communities in the U.S. and abroad. Print, digital, and audiovisual content producer experienced in writing for publication, posting on websites, and creating videos to engage, educate, and entertain English-speaking and Japanese audiences in a manner that contributes to a better functioning society.
Documentary film pitchman, producer, director, editor, and narrative strategist—with experience in the broadcasting, film, and social media sectors—focused on short-format and high-impact storytelling for social-benefit enterprises, greater-good causes, and disenfranchised populations in the healthcare, education, and social-service sectors.

Work History
Patient Intake, Patient Support, and Documentation Specialist; ReimbursementIQ; Garden Grove, CA 06/2020 – Present

Compile information essential to accelerating patient access to medically necessary healthcare products, services, and solutions—including patient informed consents (e.g., HIPAA-HITECH authorizations to share protected health information [PHI]), pharmacy and medical benefit specifics, ICD-10 diagnostic codes, CPT/HCPCS I procedure codes, HCPCS II supply codes, NDCs biopharmaceutical identifiers, prescriptions, medical histories, letters of medical necessity (LMNs), step therapy plans—on behalf of patients, guardians, healthcare professionals (HCPs), primary care practices (PCPs), multi-specialty medical groups (MSMGs), clinical centers of excellence (COEs), third-party payers (TPPs), third-party administrators (TPAs), fully insured health plan sponsors (e.g., premium-paying employers), self-funded healthcare purchasers (e.g., self-insured employers and unions), etc.

Review case information and create case-specific documentation using Office 365 applications like Word, Excel, PowerPoint, Outlook, and Access. Communicate with a broad range of healthcare stakeholders using version-controlled templates retrieved from Dropbox, Egnyte, and other cloud-based hosting solutions. Enter mission-critical data into ISO 27001, NIST, and HIPAA-HITECH compliant databases housed in on-premises servers and cloud-based environments like Azure. Support business analysts in their daily, weekly, monthly, quarterly, and annual reporting using Tableau and Alteryx. Improve patient-support hub-service efficiencies and effectiveness.

Recommend ways to improve the economic, clinical, and humanistic outcomes (ECHOs) of medical products, services, and solutions—and achieve Triple/Quadruple/Quintuple Aim endpoints (i.e., reducing per capita costs, improving population health, enhancing patient and provider experiences, and promoting health equity) while complying with legal, regulatory, and professional standards. Participate in business process reengineering (BPR) initiatives to improve corporate culture, competencies, brand equity, revenues, operating efficiencies, earnings growth, risk mitigation, competitiveness, scalability, salability, speed to favorable liquidity events, and investor metrics.

English as a Second Language (ESL) Teacher; Nakane and Titana Elementary School; Hitachinaka, Ibaraki, Japan 03/2018 to 01/2020

Improved the academic performance, moral frameworks, and public speaking skills of elementary-aged children by (1) studying educational, moral, and social standards in Japan; (2) adopting best practices in curriculum, course, and content design, development, and delivery; and (3) building students’ intellectual, moral, and physical strength in support of more purposeful, productive, and peaceful communities.

Content Producer and Editor; GGR Productions, Westminster, CA 05/2016 to 03/2018

Developed, pitched, produced, directed, edited, and distributed short films using PC and Apple operating systems; Microsoft Office 356 applications (e.g., Word, Excel, PowerPoint, Outlook, Access); story development tools like GoAnimate, Ydraw, and Celtx; cinematography equipment like Canon and RED cameras and 16 mm film; and editing software like Final Cut Pro X, Final Cut Pro 7, and Premiere Pro.

Education

Bachelor of Arts: Film and Digital Media; Concentration: Narrative Production; California State University at Long Beach; Long Beach, CA

Awards
President’s Honors List;
Hollywood Foreign Press Grant Recipient;
Winner, Best Editing (CSULB Campus Movie Festival, 2012);
Nominee, Best Independent Film (Orange County Film Festival, 2012).

Jennifer Ani

Patient Intake and Engagement Specialist

Qualifications
Bilingual patient and student advocate, case manager, and outcomes-improvement specialist with knowledge, skills, and experience in chronic care management (CCM), individualized education planning (IEP), and social-service referral programs (e.g., www.211.org, www.findhelp.org and www.benefits.gov) in HIPAA- and FERPA-compliant enterprises using Azure, Engyte, Office 365, and ERP systems.

Culturally competent expert in tech-enabled program design, development, and deployment in the healthcare, education, and social-service sectors—committed to continuous improvement in customer engagement, education, activation, adherence, and consequences under both fee-for-service (FFS) and value-based payment (VBP) models.

Equity-minded specialist in (1) expanding market access to clinical breakthroughs, best practices, and benchmarks through state-of-the-art evidence, value, and access (EVA) programs and high-touch hub services; (2) improving IEPs and student results in special education (SPED) and gifted and talented education (GATE) programs; and (3) helping individuals prevail over adverse social determinant of health (SDOHs).

Work History
Patient Intake and Reimbursement Specialist; ReimbursementIQ; Garden Grove, CA 2021 – Present

Enhance operational efficiencies and effectiveness on the frontlines of highly specialized patient-support hub services—answering and dispositioning incoming calls; building rapport with patients, healthcare professionals (HCPs), and health plan personnel; completing patient, provider, and payer intakes; and queueing up cases for skill-based handoffs to other third-party payment (TPP) specialists.

Research clinical diagnoses, confirm prescription specifics, study pharmacy benefits, evaluate medical benefits, perform insurance verifications (IVs), conduct benefit-eligibility checks, secure letters of medical necessity [LMNs], review step therapy plans, obtain prior authorizations (PAs), secure predeterminations (PDs), queue up appeals to insurance denials, and advocate for coverage exceptions.

Compile mission-critical information on coding, coverage, and contracting trends of public payers (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA), commercial payers (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence Health), and self-funded employers (e.g., Costco, Michelin, Walmart).

Assistant Manager; Dollar Tree; Orange County, CA 2017 – 2020

Protected and enhanced Dollar Tree brand equity, revenues, operating efficiencies, earnings growth, risk mitigation, and competitiveness by confirming corporate business objectives, tracking key performance indicators (KPIs) at the store level, and identifying outlier events using dashboards and scorecards. Applied analytical skills to meet sales and other quotas on a daily, weekly, monthly, quarterly, and annual basis.

Improved talent acquisition, talent development, and talent retention by modeling corporate values, clarifying performance expectations, and celebrating team successes—ensuring each team member saw a clear path to career advancement, experienced professional development, and felt personally and professionally accountable for customer satisfaction, store profitability, and corporate growth.

Assured legal, regulatory, and corporate compliance by completing micro-learning modules on labor law, health regulations, local ordinances, corporate policies, and retail best practices. Used cutting-edge software applications including human resource information systems (HRIS), financial management systems, B2B procurement systems, store-level inventory control (SLIC) systems, and B2C online ordering systems.

Special Education Teaching Assistant and Paraprofessional; Magnolia Science Academy, Santa Ana, CA 2014 – 2017

Assured compliance with the Individuals with Disabilities Education Act (IDEA) and enhanced students’ academic, behavioral, and social performance by (1) developing individualized education plans (IEPs) for individuals with moderate-to-severe disabilities; (2) targeting barriers to cognitive, emotional, and interpersonal growth; and (3) using GoalTracker software and other evidence-based methods.

After-School Teacher; Ace Academy, Cypress, CA 2014 – 2017

Improved student self-efficacy, academic development, and test scores by (1) working backwards from school assessment and program evaluation metrics to lesson plan design; (2) using motivational interviewing to identify student priorities, interests, and needs; (3) teaching reading, writing, and arithmetic; (4) modeling self-directed learning; and (5) assisting with in-classroom and homework assignments.

Education

Bachelor of Arts Degree: Political Science;
Concentration: International Relations and Public Law;
Minor: French

Mellessa Taylor

Patient Intake and Engagement Specialist

Melissa Taylor

Qualifications

Call center, data entry, and administrative specialist with 15+ years of experience (1) building rapport with customers ranging from patients and healthcare professionals (HCPs) to financial-service professionals and business owners; (2) compiling information essential to customer service, retention, and referrals; and (3) managing mission-critical administrative tasks for company professionals, managers, and leaders.

Patient intake, medical records, and insurance billing expert trusted to verify ICD-10 diagnostic codes and prescription information, research insurance benefits, perform insurance verifications (IVs) and benefit-eligibility checks, secure letters of medical necessity (LMNs) and step therapy plans, obtain prior authorizations (PAs) and predeterminations (PDs), track insurance denials, and advocate for coverage exceptions.

Special projects expert trusted to research (1) public payers (e.g., Medicare, Medicaid, CHIP, WIC, OPM/FEHB, TRICARE, VHA); (2) commercial payers (e.g., UnitedHealth, Kaiser, Anthem, Centene, Humana, CVS, HCSC, Cigna, Molina, Independence Health); (3) self-funded plans (e.g., Costco, Michelin, Walmart); (4) social-service programs (e.g., www.211.org, www.findhelp.org and www.benefits.gov); and (5) COVID issues.

Work History
Patient Intake and Reimbursement Specialist; ReimbursementIQ; Garden Grove, CA 06/2019 – Present

Answer, manage, and document incoming calls from patients, healthcare professionals (HCPs), primary care practices (PCPs), specialty medical groups (SMGs), clinical centers of excellence (COEs), third-party payers (TPPs), third-party administrators (TPAs), fully insured health plan sponsors (e.g., premium-paying employers), self-funded healthcare purchasers (e.g., self-insured employers and unions), etc.

Enter mission-critical data into HIPAA-HITECH compliant databases housed in on-premises servers or cloud-based applications like Azure. Compile patient-specific information using Office 365 applications like Word, Excel, PowerPoint, Outlook, and Access. Create case-specific reports using version-controlled templates retrieved from Dropbox, Egnyte, and other hosting solutions.

Track outlier events to provide early warnings to clinical, financial, and administrative managers on challenges that could compromise the economic, clinical, or humanistic outcomes (ECHOs) of patient care. Highlight important findings in team meetings and make recommendations for better serving company constituents (e.g., territory managers, program directors, and senior leadership teams).

Front-Desk Receptionist and Payroll Specialist; Alcorn Fence; Orange, CA (Temporary assignment during mom’s illness) 05/2018 to 06/2019

Greeted walk-ins, managed incoming calls, and made highly productive use of quiet periods by entering data into enterprise resource planning (ERP systems) by creating and managing account records, updating account specifics, entering payroll information, maintaining Excel spreadsheets and workbooks, and preparing management reports.

Call Center Representative; TaxShield; Memphis, TN (Temporary assignment during mom’s illness) 12/2017 – 03/2018

Answered incoming calls across eight states and multiple retail locations. Made 65+ calls to prospects and clients each workday. Scheduled client appointments. Performed client-related research. Filed client information. Ordered supplies. Ensured tax professionals were prepared for client meetings. Resolved client concerns, whether unspoken or verbalized. Ensured clients remained informed, engaged, and satisfied.

Caregiver; MT HomeCare Services; Memphis, TN (Temporary work during mom’s illness) 01/2016 – 11/2017

Provided concierge-quality homecare and eldercare services in a continuing care retirement community (CCRC). Reviewed prescriptions and ensured medications were taken with the right frequencies and dosages. Promoted proper nutrition through meal scheduling and meal supervision. Improved resident mental and physical fitness by coordinating with recreational instructors and physical therapy (PT) specialists.

Customer Service Representative; Ansafone Contact Center; Santa Ana, CA (Temporary assignment during mom’s illness) 08/2015 – 01/2016

Made and documented 65+ calls per day to educate patients on dental coverage and care. Exceeded performance quotas, consistently earning 10/10 ratings on call-management skills in random quality assurance checks. Provided sales support between calls, typing sales correspondence at 45+ wpm.

Data-Entry and Insurance Verification Specialist; OrthoXpress; Irvine, CA (Temporary assignment during mom’s illness) 01/2014 – 04/2014

Completed patient intakes. Conducted insurance verifications and eligibility determinations. Compiled and managed clinical, financial, and administrative information associated with healthcare professionals (HCPs) and durable medical equipment (DME) companies. Assisted with month-end closings.

Typed correspondence. Performed 10-key entry of financial information.

Front-Office and Back-Office Specialist; Avalon Rehab; Huntington Beach, CA (Temporary assignment during mom’s illness) 07/2013 – 01/2014

Managed calls from patients, healthcare professionals (HCPs), and health plans. Scheduled appointments. Created, updated, managed, filed, and retrieved patient charts. Compiled insurance information (e.g., pharmacy and medical benefits). Verified eligibility. Submitted statements of medical necessity (SMNs). Obtained prior authorizations. Collected co-pays. Performed billing and collections.

Lease Administrator and Sales Assistant; SoCal Office Technologies; Cypress, CA (Left due to mom’s illness) 01/2010 – 04/2013

Assured complete, accurate, and precise recordkeeping around equipment leases.

Provided hands-on support to the Vice President of Sales, Sales Teams, and Branch Office Personnel to fill the sales pipeline, accelerate speed to deal closure, expand account footprints, and improve lifetime value of customers.

Captured information on credit worthiness, incoming orders, delivery schedules, special requests, and accounts receivable (A/R).

Tracked acquisition and distribution of laptops, blackberries, gas cards, etc., to corporate personnel. Assisted customers with financial-service activities such as acquiring bank loans for capital equipment purchases. Helped warehouse managers with month-end inventory checks.

Accounts Receivable Specialist; Financial Data Management, Inc.; Santa Ana, CA (Business owner chose to close shop) 06/2007 – 01/2009

Recorded patient information in support of insurance verifications (IVs), prior authorizations (PAs), and evidence-based insurance billing under Medicare, Medicaid, UnitedHealthcare, Blue Cross and Blue Shield, and other insurance plans.

Posted checks. Verified electronic funds transfers (EFT wires). Adjusted patient accounts and out-of-pocket (OOP) collections based on third-party payer (TPP) and third-party administrator (TPA) specifics, summary plan descriptions (SPDs) for relevant health plans, insurance coverage policies, individual deductibles, family deductibles, co-pays, co-insurance, reimbursement allowables, etc.

Patient Registration Representative and Benefits Coordinator; St. Jude Medical Center; Fullerton, CA 06/2005- 07/2007

Served as a go-to resource and hands-on manager over insurance-related operations. Oversaw patient intakes. Ensured team members properly verified insurance in relation to MRIs, CTs, and other high-cost imaging procedures.

Scheduled in-patient and outpatient surgeries.

Acted as a liaison on behalf of patients, nurses, physicians, case managers, and administrators.

A/R Representative; Apria Healthcare; Lake Forest, CA 10/1996- 05/2005

Mastered health insurance coding and medical terminology to support patient intake, insurance verification, prior authorization, billing, and collections functions.

Managed data entry associated with ICD-9 diagnostic codes, American Medical Association (AMA) current procedural terminology (CPT) codes (aka Centers for Medicare and Medicaid Services [CMS] HCPCS Level I codes), CMS HCPCS Level II codes, etc.

Assigned new product, service, and solution codes based on best practices in insurance coding. Maintained master pricing schedules, reflecting fair market value and usual, customary, and reasonable (UCR) charges. Entered product data into JDE and ACIS systems.

Improved patient intake procedures, third-party payment (TPP) related processes, and evidence-based billing procedures.

Streamlined accounts receivable (A/R) functions. Accelerated collections and reduced days sales outstanding (DSO, the time between product or service delivery and receipt of payment).

Education
Associate of Arts Program: Computer-Based Office Systems; Coastline Community College; Fountain Valley, CA
Certificate, Office Support Specialist; Coastline Community College; Costa Mesa, CA