Teresa Anderson

Enrolled patients diagnosed with various types of cancer to receive radioligand therapies of Pluvicto or Lutathera.

Conducted comprehensive benefit verifications with insurance companies to verify coverage for radioligand therapies.

Assisted providers and infusion centers with obtaining prior authorizations, pre-determinations, coverage exceptions and appeals needed to obtain insurance approval for radioligand therapies.

Enrolled eligible patients in copay assistance programs or alternate funding programs based on financial needs.

Coordinated treatment referrals between physicians and ifusion centers to expedite start of treatment.

Counseled patients, caregivers and providers about the enrollment process, insurance benefit details, financial assistance options, and what to expect before, during and after treatment.

Reported any potential adverse drug effects or technical quality issues to the pharmaceutical company.

Researched and re-billed rejected pharmacy copay assistance claims in live time for pharmacies, patients and other healthcare professionals.

Researched and re-billed rejected medical copay assistance claims based on claim forms and explanation of benefit forms received from physicians and insurance providers.

Entered backdates, claim overrides and claim reversals per program guidelines.

Researched and completed internal claim escalation requests to resolve trending claim rejections with Sanofi.

Enrolled eligible patients in a variety of copay assistance programs offered by Sanofi.

Researched alternate funding programs for uninsured or under-insured patients.

Trained and educated new staff members.

Reported any potentially adverse drug effects or technical complaints to Sanofi management.

Assisted management with any special projects as needed.

Enrolled patients diagnosed with ALS to receive an infusion therapy called Radicava.

Conducted comprehensive benefit verifications with insurance companies to verify coverage for Radicava therapy.

Assisted providers and infusion centers with obtaining prior authorizations, pre-determinations, coverage exceptions and appeals needed to obtain insurance approval for Radicava therapy.

Enrolled eligible patients in copay assistance programs or alternate funding programs based on financial needs.

Counseled patients, caregivers and providers about the enrollment process, insurance benefit details, financial assistance options, and what to expect before, during and after treatment.

Processed and completed Radicava drug orders submitted by infusion centers.

Researched and relayed any escalated case issues to McKesson and MT Pharma management.

Trained and educated new staff.

Reported any potential adverse drug effects or technical quality issues to the pharmaceutical company.

Assisted management with special projects as needed.

Tracked and analyzed large batches of aberrant and rejected claim data to identify and extrapolate current rejection trends from numerous health plans.

Trend and analyze monthly payments received by numerous health plans in comparison to the percentage of rejected claims.

Escalated claim processing and payment issues with management and health plan representatives during monthly Joint Operation Committee meetings.

Monitored escalated claims for payment resolution from their respective health plans.

Presented weekly and monthly claim resolution statistics to management and health plan representatives.

Initiated and conducted individual provider and facility claim investigations based on aberrant billing data compiled from a variety of referral sources.

Analyzed large batches of claim data to extrapolate billing inconsistencies and errors identified by data mining systems and fraud monitoring units within Optum Insight.

Requested medical records directly from physicians and various healthcare facilities.

Ensured secure delivery of medical records and Protected Health Information reached appropriate clinical review teams.

Processed invoices received for the duplication of medical records, and ensured amounts charged were in accordance with state laws and provider contracts.

Reported any additional claims suspected of fraud, waste and abuse to the appropriate investigative authorities.