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Reimbursement Specialist with 5+ years of healthcare operations expertise
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Competencies
Reviewed insurance benefits, verified coverage details, and coordinated with payors to ensure accurate benefit information.
Trained and supported team members on insurance workflows, improving team accuracy and process consistency.
Managed high-volume benefit inquiries, maintained detailed case records, and ensured compliance with healthcare policies.
Participated in projects to enhance case handling procedures, reducing bottlenecks and aligning with SLAs.
Collaborated with care, medical, and quality teams to streamline processes and resolve coverage issues efficiently.
Education
Summary
Dedicated healthcare professional with over 5 years in benefits verification, insurance investigation, and team leadership within pharmaceutical and health services sectors. Proven ability to manage complex cases, mentor staff, and optimize workflows to enhance accuracy and efficiency.
Key Achievements
- Led benefit verification process for Novartis medicines, ensuring accurate coverage info and timely provider reimbursements.
- Mentored new team members at Novartis, standardizing insurance verification procedures and documentation standards.
- Oversaw benefit verification for oncology medications at McKesson, supporting patient financial programs and improving workflow efficiency.
Experience
Reimbursement Specialist
Lead benefit verification process for prescribed Novartis medicines by contacting payors, documenting findings, and ensuring provider offices receive accurate and timely coverage details in alignment with departmental SLAs., Mentor new team members on insurance verification procedures, case...
Case Manager
Oversaw benefit verification for oncology medications, reviewing insurance benefits, providing coverage details to providers, and coordinating patient financial assistance programs., Trained and supported team members on insurance verification workflows, system usage, and documentation best...
Administrative Clerk/Processor
Provided administrative support to Team Leader and Operations Manager, processing legal documents required for subpoenas., Verified accuracy of court documents and ensured proper filing and recordkeeping.