Summary
Overview
Work History
Skills
Timeline
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Erin Rosa

Leominster,MA

Summary

Dynamic Reimbursement Specialist at Allcare Plus Pharmacy with expertise in prior authorization processing and effective denial resolution. Proven track record in maintaining HIPAA compliance while enhancing client support. A proactive self-starter, with exceptional strategic task management and have successfully resolved discrepancies, ensuring seamless operations and positive patient outcomes.

Overview

10
10
years of professional experience

Work History

Reimbursement Specialist

Allcare Plus Pharmacy
08.2019 - Current
  • Conducted audits on patient accounts to detect inaccuracies or inconsistencies via reports.
  • Maintained up-to-date knowledge of insurance policies, guidelines, and regulations.
  • Customer Service; Inbound/Outbound phone calls and faxes.
  • Benefits Investigations Prior authorizations and Appeal submissions and follow up with payers and Providers.
  • Maintain positive relationship with client, physician’s office staff and patients.
  • Copay assistance screening and enrollment.
  • Special projects including problem solving and Multiple unique Pharmacy rejections.
  • Auditing 100's of Patient profile via reporting updates.
  • Resolved patient disputes regarding insurance coverage, co-pays, and deductibles.
  • Participated in workshops and seminars via LinkedIn to continuously improve personal skills related to position.
  • Contributed to team effort by meeting performance goals and assisting colleagues when needed.
  • Managed difficult customer situations with professionalism and empathy.
  • Trained new Customer Service Representatives on company policies, procedures, and best practices.
  • Answered customer inquiries via phone, email, and chat.
  • Escalated issues that could not be resolved independently to supervisors or managers for further assistance.
  • Documented all call information according to standard operating policies and procedures.
  • Set up customer accounts in system and updated details to reflect current information.

Administrative Assistant

Manor on the Hill
04.2018 - 08.2019
  • Prioritized incoming 25 or more daily emails and phone calls to ensure timely responses from appropriate personnel.
  • Supported human resources department by updating employee files as needed.
  • Created visually appealing presentations using PowerPoint or similar software programs.
  • Handled sensitive information with discretion while maintaining confidentiality protocols.
  • Proofread documents for grammar, spelling, and formatting errors before distribution.
  • Assisted with event planning, including booking venues, arranging catering, and coordinating logistics.
  • Maintained inventory of office supplies and placed orders.
  • Trained new administrative staff members in company procedures and best practices.
  • Managed daily office operations and maintained organized workspace.
  • Created and maintained databases used by multiple office members.
  • Delivered range of basic and advanced clerical support for daily and special project needs.
  • Ordered, dispensed, and organized office supplies for team use.
  • Compiled records, materials and forms needed to handle different requests.
  • Offered professional first impression to visitors and callers and gave knowledgeable assistance.
  • Managed incoming and outgoing mail, packages and faxes.

Director of Medical Records and Central Supply

Gardner Rehabilitation and Nursing Center
04.2017 - 04.2018
  • Maintained relations with clinical staff on organization of charts and records on 4 separate units.
  • Ordering of all medical, office and janitorial supplies for the 150 bed facility.
  • Maintaining a working par level for all items needed to ensure that the facility may function properly and efficiently.
  • Ensured compliance with all relevant regulations, policies, and procedures.
  • Collaborated with Nursing, Billing and scheduling departments to streamline processes and improve communication.
  • Created and implemented budgets, monitoring expenses to control costs.
  • Assessed risks associated with various decisions or strategies before implementation.
  • Implemented new technology solutions to improve efficiency or effectiveness.
  • Negotiated contracts with vendors and suppliers for better terms or pricing.
  • Organized regular inventory counts to keep records accurate and identify supply needs or loss points.
  • Reviewed operations regularly to identify and capitalize on opportunities to eliminate waste.
  • Evaluated supplier performance by price, quality and on-time delivery.

Customer Quality Specialist

Lincare Home Oxygen And Respiratory Systems
11.2015 - 04.2017
  • Maintained confidentiality of all information and assured that all transactions are completed and accurate.
  • Reviewed and analyzed data to ensure accuracy of data.
  • Answered over 40 calls per day on a multi-line phone system.
  • Scheduled appointments and took messages for the Clinical staff.
  • Cooperated with Medicare, Medicaid, and private insurance companies.
  • Insurance verifications for multiple products and services.
  • Ensured adherence to company policies and guidelines in handling customer concerns.
  • Collaborated with 3 or more departments to address customer issues.
  • Resolved customer complaints in timely and effective manner.
  • Acted as liaison between customers, sales teams, and technical support staff to resolve product or service-related issues promptly.
  • Acknowledged and directed customer requests for additional products or services to appropriate licensed representatives.
  • Updated records with details of customer interactions and transactions.
  • Documented all call information according to standard operating policies and procedures.
  • Set up customer accounts in system and updated details to reflect current information.
  • Conferred with customers by telephone or in-person to provide information about products or services.
  • Kept records of customer interactions or transactions, recording details of inquiries and actions taken.

Skills

  • Service excellence
  • Expertise in HIPAA compliance
  • Insurance eligibility assessment and management
  • Effective denial resolution
  • Client support
  • Proactive self-starter
  • Consistent deadline management
  • Strategic task management
  • Clear and concise communication skills
  • Effective documentation practices

Timeline

Reimbursement Specialist

Allcare Plus Pharmacy
08.2019 - Current

Administrative Assistant

Manor on the Hill
04.2018 - 08.2019

Director of Medical Records and Central Supply

Gardner Rehabilitation and Nursing Center
04.2017 - 04.2018

Customer Quality Specialist

Lincare Home Oxygen And Respiratory Systems
11.2015 - 04.2017

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Erin Rosa