Case Management Specialist, Rare Diseases – Tzield - Sanofi Pharmaceuticals - Charlotte, NC (Remote)
(2023-08)
Manage a high-volume caseload of 40+ concurrent cases, leading the case management process with urgency and purpose while prioritizing acuity, timelines, compliance requirements, and balancing individual patient needs with organizational business objectives.
- Assess patient access needs, developed treatment initiation/continuation plans, and facilitated insurance approvals for rare disease therapies.
- Educate patients, caregivers, and healthcare providers on insurance options, requirements, limitations, and approval processes.
- Maintain expert knowledge of reimbursement procedures, payer trends, billing/coding protocols, and patient assistance resources.
- Enroll qualified patients into financial assistance programs, ensuring ongoing therapy access.
- Apply up-to-date regional resources and market knowledge to improve patient access outcomes.
- Coordinate compliant exchange of patient information with internal and external stakeholders.
- Identify complex patient-specific challenges, created actionable solutions, and ensured execution with measurable results.
- Build and maintain strong relationships with cross-functional teams, insurers, specialty pharmacies, and clinical site staff.
- Represent the organization at patient meetings, site visits, conferences, and trade shows.
- Contribute to team growth by sharing reimbursement expertise, training peers, and supporting complex case reviews.
- Maintain precise documentation of insurance coverage, approvals, requirements, and all interactions.
- Leverage CRM tools and data analytics for strategic territory planning and prioritization.
- Provide territory coverage as needed while ensuring compliance with all policies.
Insurance Verification Specialist - Provention Bio – A Sanofi Company - Charlotte, NC
(2023-04 - 2023-08)
- Conducted comprehensive benefit verification for patients, including cost share and coverage limitations.
- Documented insurance plan details, provider options, and prior authorization requirements.
- Investigated payer processes for prior authorizations, appeals, and peer-to-peer reviews.
- Identified access barriers and escalated issues to appropriate internal teams.
- Completed quality reviews and maintained accurate Salesforce CRM documentation.
- Communicated updates and trends to team via Microsoft Teams and CRM collaboration tools.
Customer Service Specialist (Provider Services) (Contract Role) - Epiq Systems - Charlotte, NC
(2022-11 - 2023-03)
- Assisted healthcare providers by verifying eligibility and claim status.
- Reviewed paid, pending, and denied claims and explained denial codes.
- Provided guidance on claims submission and appeals processes.
- Escalated complex issues to claims department and supported dispute inquiries.
Contact Center Representative II (Class Action / Remediation / Special Cases) (Contract Role) - Epiq Systems - Charlotte, NC
(2022-08 - 2022-10)
- Managed inbound/outbound calls, emails, and chat support for specialized case work.
- Resolved customer inquiries and escalated complex issues as needed.
- Performed data entry, research, and documentation for case records.
Billing Account Specialist - Charter Communications Spectrum - Charlotte, NC
(2021-05 - 2022-06)
- Provided first call resolution for billing and account inquiries.
- Processed payments, adjusted services, and resolved billing disputes.
- Ensured accurate documentation and customer confidentiality.
Marketing – Circulation Administrative Coordinator & Customer Service Rep - American City Business Journals - Charlotte, NC
(2019-03 - 2021-01)
- Provided customer support for subscriptions, orders, and billing.
- Managed order fulfillment and payment processing.
- Maintained customer database and invoicing records.
- Upsold products and supported sales initiatives.
Seasonal Benefits Verification Specialist (Contract Role) - AmerisourceBergen, Lash Group
(2017-10 - 2019-02)
- Conducted benefit verification with private and public healthcare payers.
- Verified medical benefits and updated patient insurance profiles.
- Followed up with payers for re-verification and resolved discrepancies.
- Submitted documentation and ensured accurate patient benefit records.
Customer Service Associate (Contract Role) - Duke Energy - Charlotte, NC
(2018-03 - 2018-07)
- Handled inbound calls and resolved billing/credit inquiries.
- Managed account updates, service requests, and payment arrangements.
Customer Service Specialist (Provider Services) (Contract Role) - Conduent - Charlotte, NC
(2017-05 - 2017-10)
- Assisted providers with insurance benefits and claims research.
- Verified policy details and resolved provider inquiries.
Customer Service Healthcare Professional (Contract Role) - Aon Hewitt Associates - Charlotte, NC
(2017-01 - 2017-04)
- Assisted employees with benefits enrollment and healthcare plan questions.
- Verified coverage and explained plan options and networks.
