Field Reimbursement Access Specialist - Xcenda/AmerisourceBergen/Immunology Field Services
(2017-05)
- Prior Authorization and appeal submission assistance
- Specialty Pharmacy support
- Partnering with sales team to determine priorities and follow-up required for office needs
- Deliver case status updates to sales team and hub
- Educating provider offices on local and regional payer issues, coding changes, and appropriate claims submission processes
- Liaising with reimbursement hotlines regarding alternative funding/financial assistance programs
- Assisting with determining coverage and access options available for a specific medication or procedure
- Territory management of strategic routing, booking travel, submitting expense reports
TERRITORY CASE MANAGER for Norditropin/Novo Nordisk - CVS Health
(2015-03 - 2016-11)
- Communicated with key medical practice accounts, sales representatives, and patients regarding the status of cases.
- Provided consultative services where issues arise on how obstacles can be overcome to get patient on paid therapy.
- Communicated with internal partners to ensure case coordination.
- Coordinated care for patients using the program services
- Investigated drug cost and step therapy requirement
- Reviewed and report missing clinical charts needed per ICD-9 and ICD-10 diagnosis
- Obtained approval for Written and Verbal Prior Authorizations with PBMs
- Initiated Appeals via Peer to Peer Clinical Reviews
- Triaged prescriptions to specialty pharmacies
- Coordinated Nurse Training
- Screened patients using annual income and drug cost for possible Copay Assistance and Free Drug Program
TERRITORY CASE MANAGER for Cimzia/UCB - CVS Health
(2014-11 - 2015-03)
- Acted as a partner with pharmaceutical sales representatives in supporting prescriber offices and patients in moving cases to paid therapy as needed within program policies and procedures
- Conducted calls to verify all benefits under the medical and pharmacy benefits
- Conducts calls to verify coordination of secondary and tertiary payers
- Provided all forms for Pre-Certification
- Reported Step-Therapy Requirements
- Verified that medication delivery and home health nurse is scheduled
- Reported Adverse Events (AE)
- Reported on Product Quality Complaints
- Maintained all patient confidentiality
- Updated prescribers and Sales Representatives on the case status
- Coordinated and scheduled weekly conference calls with Sales Representatives to review status of cases
MEDICAL REIMBURSEMENT SPECIALIST for Qysmia/Vivus - CVS Health
(2014-02 - 2014-11)
- Ran test claims under pharmacy benefits
- Reviewed weight and BMI requirements for weight loss drug
- Called doctor's offices to explain and promote program services to doctors' offices
- Conducted verbal prior authorizations with PBM to approve medication
- Followed up with office to assist in appeals
HIGH SCHOOL SPANISH TEACHER - New Smyrna Beach High School - FL
(2005 - 2010)
