chadadams

Manage specialty medication access across a six-state territory and work with provider offices to resolve insurance and reimbursement barriers. Assist offices with specialty pharmacy/buy-and-bill issues and coordinate with alternate sites of care when appropriate. Review benefits, payer policies, prior authorization requirements, claims, and billing information to determine what is delaying treatment and what action is needed. Coordinate with provider offices, payers, specialty pharmacies, and internal teams to track cases, resolve escalations, and communicate next steps. Help office staff use manufacturer support programs and understand the documentation needed to complete enrollments

Supported employer-group benefits administration, audited enrollments for accuracy, and coordinated carrier requirements and enrollment data across client systems

Manage specialty medication access across a six-state territory and work with provider offices to resolve insurance and reimbursement barriers. Assist offices with specialty pharmacy/buy-and-bill issues and coordinate with alternate sites of care when appropriate. Review benefits, payer policies, prior authorization requirements, claims, and billing information to determine what is delaying treatment and what action is needed. Coordinate with provider offices, payers, specialty pharmacies, and internal teams to track cases, resolve escalations, and communicate next steps. Help office staff use manufacturer support programs and understand the documentation needed to complete enrollments

Educated employer-group members on benefits, coverage guidelines, and claims; investigated claim issues and initiated reprocessing when appropriate

Reviewed and processed prescription coverage determinations in accordance with plan requirements and regulatory guidelines; prepared reconsideration appeal packets for submission to Maximus and completed compliance-related documentation and reporting

Supported members with benefit, claim, and enrollment issues and contributed to projects focused on improving call-center performance metrics.

Consulted with prospective clients in person and by phone to assess healthcare coverage needs and recommend appropriate health plan options. Developed a SharePoint-based telephonic enrollment system for the department and created a tool used to support federal call-center audits.