Nadia Vasques

Experience

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  BMC HealthNet Plan/Well Sense Health Plan

  Nov 2009 - May 2017

  Ability to multi-task and prioritize various projects/assignments with little to no supervision such as Warnings and Errors, reconciliations, discrepancy reports, PCP terminations and much more. Research and reconcile member eligibility discrepancies identified via the daily Warning & Errors report and the weekly 834 Reconciliations Report.Process Notice of Birth (NOB) Forms by reconciling Temporary IDs (T Records) with permanent IDs and record newborn statistics in Facets for Health Services Contract Management reporting.Demonstrates great communication and collaboration skills within the department as well as to other departments to resolve complex issues related to member eligibility and provider discrepancies.Willing to take on any project without hesitation and am able to learn new skills quickly.Assigns providers to members using defined guidelines.Researches and resolves provider issues received in the department from both internal and externalcustomers and also identified in the daily reports.Updates member demographic information in Facets database and MH website.Generates member identification cards and packets.Enters and tracks returned mail in Excel database and mailing letters with new addresses to thecorrect address. Show less

  • Member Enrollment Representative III

    Jan 2015 - May 2017

  • Member Enrollment Representative I

    Nov 2009 - Jan 2015
• 

  Alkermes

  May 2017 - now

  Act as a single point of contact and subject matter expert regarding the acquisition, fulfillment and reimbursement for multiple Alkermes products, while providing the highest level of customer service Develop working relationships with internal and vendor teams, needed to provide coordinated support to healthcare providers and patients Provide updates and account information to key internal Alkermes stakeholders such as field sales, national accounts, field reimbursement managers and key account managers Demonstrate proficiency and full understanding of Alkermes PAS processes and database including understanding of data elements, definition of various case statuses and outcomes, case documentation requirements and the importance of meeting program metrics Accurately document call details, follow up actions, and any other pertinent information in the Alkermes PAS database Gain familiarity with reimbursement and coverage requirements for health plans within their assigned geographic territories to assist with troubleshooting and resolution of ongoing issues Identify and escalate customer concerns and program trends to patient access services management team and reimbursement access specialists Assess patient enrollment for Alkermes financial assistance programs including copay savings and patient assistance programs Assist with patient transition from inpatient/residential sites of care to outpatient treatment Provide back up as needed for other case managers, and members of the patient services team Assist and/or lead special projects and pilot inititiaves Participate in, and provide input to program design and implementation, along with systems testing Adhere to Alkermes standard operating procedures and compliance requirements Show less Acted as a single point of contact and subject matter expert regarding the acquisition, fulfillment and reimbursement for Alkermes products while providing the highest level of customer service.Provided updates and account information to key internal Alkermes stakeholders such as field sales, national accounts and field reimbursement managers.Identified and escalated customer concerns and program trends to patient access services management team and reimbursement access specialists.Assisted with troubleshooting and resolution of ongoing issues with reimbursement and coverage requirements for health plans within assigned geographic territories.Assessed patient enrollment for Alkermes financial assistance programs including copay savings and patient assistance programs.Coordinated with Nursing Team to assist with patient transition from inpatient/residential sites of care to outpatient treatment. Show less Responsible for processing incoming service requests and inquiries to the Alkermes PAS programs.Requests/Inquiries may be received via fax, telephone calls, website inquiries, e-prescribing software, and/or any other modes of transmission supported by the Alkermes PAS team.Enter patient and provider information received on enrollment forms into the Alkermes PAS database.Forms are submitted by healthcare providers requesting reimbursement and nurse coordinator support for patients that are prescribed Alkermes products. Triage updates and follow up activities per program processesProvide the highest level of customer service and support for inbound phone calls to the Alkermes PAS customer service line, Consisting of general inquiries from callers including healthcare providers, patients and caregivers with questions related to Alkermes productsMaintain Alkermes healthcare provider records to ensure information to ensure accuracyAccurately maintain and document information related including call details, follow up actions, and any other pertinent information, in the Alkermes PAS databaseIdentify and escalate customer concerns to PAS management team and case managers.Other duties, as needed to support program operations Show less

  • Senior Reimbursement Access and Case Manager

    May 2020 - now

  • Reimbursement Access and Case Manager

    Jul 2019 - May 2020

  • Enrollment Coordinator

    May 2017 - Jul 2019