Melanie Cambron

To passionately serve as a partner to service the needs of clients and patients through reimbursement and access support programs for long term therapies

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)

Bachelor of Arts - Spanish - UNIVERSITY OF LOUISVILLE (2005)