Syneos Health Commercial Solutions

• Educated healthcare personnel on access support strategies with national and regional health plans.
• Coordinated speaker programs to facilitate Bio-Coordinator reimbursement and access.
• Collaborated strategically with internal stakeholders in a matrix structure to support targeted customer accounts.
• Consistently achieved metrics and goals in territory logistics management.

Access and Reimbursement Manager- Dermatology

Occam Health Services

Support and address questions related to coverage requirements using a multi- channel approach to
enhance the experience of HCPs by providing virtual engagements using approved tools, while also
providing in-person engagement when necessary
Leverage effective questioning, critical thinking, and problem-solving skills to identify key customer
insights
Manage the entire reimbursement process from patient enrollment/ initiation to payer prior authorization,
appeals/denial procedures, and completion of necessary forms
Cultivate strong relationships with healthcare practices to facilitate the removal of reimbursement
barriers for specialty products and ensure patients' access to appropriate therapies
Monitor and identify market access trends from local, regional, or national payers within assigned
geographic areas
Educate healthcare professionals and office staff on patient assistance programs and their crucial role in
facilitating access to therapy for eligible patients.

Field Reimbursement Manager

UBC - Abbvie (contract)

Non Clinical Supervisor

Xcenda

In targeted accounts; Establish relationships within a practice by working closely with them in overcoming payer access and reimbursement issues.
Interact with key stakeholders within Clinics, Hospitals, Outpatient facilities & Private Practices. Handle escalated reimbursement issues related to prior authorizations and appeals.
Educate providers on product fulfillment pathways, including buy and bill retail pharmacy options. Specialized reimbursement knowledge within the Gastroenterologist disease states.
Liaising with reimbursement hotlines (HUB Services) regarding alternative funding/financial assistance programs. Educate HCP personnel on Patient access, provide guidance to HCP regarding payer coverage.
Educate physician office staff on the use of our client's patient assistance and call center support services, including web-based provider programs.
Track progress of patient cases and monitor coverage status; provide specific provider reimbursement support. Effective utilization of data and analytical dashboard.

OHAWB

Oversee daily workflow within the Billing Department.
Ensure the team maintains a daily focus on productivity and quality standards. Manage timely and accurate submissions of daily claims.
Manage application of payments, denials, re-billing, and maintaining daily and monthly collection logs and reports.
Post daily cash log and lock box payments, prepare and post office mail deposits.
Review and validate all refund requests and forward to Office Administrator for processing. Ensure the timely performance of follow-up activities with patients and/or Physicians.
Review and audit staff work, and any daily issues that may arise.
Keep self and staff current regarding Medicare, Medicaid, and insurance provisions and regulations. Hire, coach, counsel and provide performance evaluations of team members.

Billing Department Manager

Spearheaded reimbursement support team during open enrollment period verification of BI and PA reimbursement
support project; mentored and coached 25 staff members; performed data quality audits; developed process flow,
detailing correct insurance benefits investigation protocol.
• Educated staff during the access process, which includes formulary coverage/utilization management criteria,
insurance forms and procedures, benefits investigation, prior authorization, appeal, and claims resolution to
secure maximum reimbursement.
• Bill daily and monthly charges utilizing CPT, HCPCS, and ICD10 codes according to applicable guidelines.
• Evaluated denials and partial payments to determine if further reimbursement was valid.
• Performed billing and payment data analysis, reconciled and audited assigned insurance and patient accounts to
determine all insurance payments have been received per contract

Lead Medicare Reimbursement Analyst

Field Reimbursement ManagerI Immunology, Neurology, Oncology and Hematology| Medicare |Medicaid| Patient Assistance Programs| Reimbursement Strategies

As a dedicated Field Reimbursement Manager my role revolves around enhancing healthcare provider experiences and ensuring patient access to critical therapies. My recent work includes managing the intricate process of patient reimbursement from initiation to completion, including prior authorizations and appeals procedures.

With a strong foundation in analytical skills and business management, I've successfully cultivated relationships within healthcare practices, focusing on removing reimbursement barriers for specialty products. The team has effectively utilized virtual and in-person strategies to solve complex coverage issues, ensuring a seamless support system for healthcare professionals and patients alike.

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Dorette Shirley, PACS's Linkedin Analytics

Dorette Shirley, PACS

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