Stephanie Castillo
Lynn
Summary
Dedicated Patient Support Specialist with 2 years of experience in the pharmaceutical industry, specializing in rare disease. Proven ability to navigate complex healthcare systems, facilitate patient access to life-saving therapies, and provide compassionate support to patients and families. Expertise in pharmaceutical access and reimbursement and payor structures to ensure optimal care.
Overview
13
13
years of professional experience
19
19
years of post-secondary education
Work History
Patient Support Specialist
Vertex Pharmaceuticals
3 2022 - Current
- Manage a caseload of 250 patients, ensuring personalized support, resolve access issues, and provide ongoing support throughout the treatment journey
- Maintain meticulous records of interactions, outcomes, and compliance with regulatory guidelines
- Maintain up-to-date knowledge of reimbursement policies specific to specialty medications
- Build meaningful connections with external partners, including health care providers and specialty pharmacies
- Utilize analytical tools to proactively monitor and rapidly respond to trends
- 2 years participating on the Patient Services Reimbursement REP team
Supervisor, Patient Accounts & Managed Care Department
All Care VNA of Greater Lynn
1 2021 - 3 2022
- Supervised a team of 6 patient account representatives
- Lead and increased team productivity by implementing efficient workflows and setting clear expectations for staff members
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Maintain up-to-date knowledge of the billing and reimbursement process to provide effective filing strategies
- Assist and educate patients with insurance matters - billing, COB, eligibility
- Verify current insurance coverage policies and benefit details through direct contact with Medicare, Medicaid, and Commercial insurances
- Responsible for the resolution of complex denials through appeal process
- Implemented a paperless process for our Managed Care department
- Served as liaison between claims processors, subscribers, providers to resolve prior authorization denials
- Established and maintain professional and effective relationships with all internal and external clients including but not limited to care coordination colleagues, insurance company case managers, clinicians and office coordinators
Team Lead, Patient Account Representative & Managed Care Department
All Care VNA of Greater Lynn
08.2019 - 01.2021
- Oversaw daily functions of Managed Care department
- Assisted with the training of Billing personnel
- Assisted Operations Director with resolutions of complex matters
- Responsible for coordinating and resolving complex denials
- Prepared and corrected the accounts receivable reconciliation report by processing month-end Special Billing
- Implemented process improvements that led to reduced turnaround times for critical tasks without compromising quality
- Established clear performance metrics for the team which helped in tracking progress towards set targets effectively
- Coached team members in techniques necessary to complete job tasks
Patient Accounts Representative
All Care VNA of Greater Lynn
08.2017 - 08.2019
- Maintained accurate records of customer accounts, payments and payment plans
- Processed claims: Commercial and Private insurance
- Electronically submitted bills according to compliance guidelines
- Ensured compliance with healthcare regulations while processing claims and managing patient accounts.
- Demonstrated adaptability in navigating complex payer guidelines to maximize reimbursement opportunities for the organization
- Developed strong relationships with key contacts at insurance companies to expedite resolution of claim disputes or other account-related issues.
- Kept up-to-date on Medicare and Medicaid trends, sharing knowledge with team members to support their professional development and enhance overall performance.
- Streamlined processes for claims adjudication, resulting in faster resolution of payment disputes
- Receive payments, prepare deposits, post payments and balance out to Accounting Department month end reports
- Troubleshoot and resolve billing issues on problem accounts with minimal supervision
- Served as a liaison between patients, insurances and home care agency personnel
- Complete Monthly Aged Receivables
- Prepare and correct the accounts receivable reconciliation report by processing the month-end Special Billing
- Insurance Verifier
Managed Care Specialist
All Care VNA of Greater Lynn
06.2012 - 08.2017
- Managed authorizations for patients covered by Managed care insurances, Medicaid, and Free Care by obtaining and tracking initial and ongoing authorizations
- Monitored trends in the managed care industry to anticipate changes and implement effective solutions.
- Educated patients and family members regarding insurance options and requirements necessary to initiate and maintain home care services
- Communicated effectively to insurance company, case managers, clinical staff, and billing staff
- Initiated the data entry process of McKesson for tracking Home Health and Therapy authorizations
- Participated in planning, implementation, and evaluating policies and procedures related to authorizations
- Developed training programs for new hires to quickly familiarize them with company policies and procedures
Member Services- Pharmacy Specialist
Tufts Health Plan
04.2011 - 06.2012
- Handled queue of 30-50-member phone calls with urgent pharmacy issues and providing a resolution within a 24-hour time frame
- Responsible for resolving complex claim denials for members by communicating with physician offices and pharmacies to obtain expedited authorizations
- Provided accurate information to members regarding eligibility, enrollment policies, and benefits
- Processed claims: Commercial and Private insurance
- Data entry.
Education
Bachelor of Science - Health Care Management
Bay State College
Boston, MA 05.2001 - 05.2020
Certified Medical Assistant - undefined
Salter School
Skills
Patient Advocacy
Languages
Spanish
Native or Bilingual
Timeline
Team Lead, Patient Account Representative & Managed Care Department
All Care VNA of Greater Lynn
08.2019 - 01.2021
Patient Accounts Representative
All Care VNA of Greater Lynn
08.2017 - 08.2019
Managed Care Specialist
All Care VNA of Greater Lynn
06.2012 - 08.2017
Member Services- Pharmacy Specialist
Tufts Health Plan
04.2011 - 06.2012
Bachelor of Science - Health Care Management
Bay State College
05.2001 - 05.2020
Patient Support Specialist
Vertex Pharmaceuticals
3 2022 - Current
Supervisor, Patient Accounts & Managed Care Department
All Care VNA of Greater Lynn
1 2021 - 3 2022
Certified Medical Assistant - undefined
Salter School
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