Conisha Riley

Experience

• 

  Wells Fargo

  Sept 2012 - Jun 2014

  Customer Service Representative

  -Support customers with inquiries on financial products and services-Identify ways to improve customer experience within established procedures-Perform routine customer support tasks by responding to and resolving customer inquiries and complaints-Receive direction from customer service supervisor-Escalate questions and issues to more experienced representatives-Interact with immediate customer service team as well as internal and external customers on incoming questions and concerns. Show less

• 

  Verizon

  Jun 2014 - Oct 2016

  Customer Service Specialist

  -Demonstrated self-discipline, time management, ability to collaborate virtually.-Experience resolving customer issues, billing, and/or handling product Q&A.-Promoting and/or selling products and services.-Demonstrated communication skills.-Troubleshooting

• 

  Cencora

  Oct 2016 - now

  • Serves as the primary point of contact for assigned sales representatives and field reimbursement managers.• Demonstrates expertise in healthcare payers and policies by effectively managing and resolving complex accounts resulting in a high success rate in claim reimbursements.• Responsible for understanding customer needs and strategic initiatives, working cross-functionally with the sales team and specialty pharmacies to focus on issue resolution, and delivering a positive customer experience.• Independently analyze, report, resolve, and communicate reimbursement trends and delays (e.g., billing denials, claim denials, pricing errors, and payments).• Finalize and submit all necessary insurance forms and electronic claims for timely payment. Show less • Controlled and managed document processes by thoroughly reviewing enrollment forms and insurance documents to verify accuracy and ensure strict compliance with company policies and procedures.• Identified alternate funding sources for patients’ out-of-pocket (e.g., Copay programs, Patient Assistant Programs, and Medicaid). • Performed monthly audits of program productivity achieving a 97% contract compliance rate for the fiscal year.• Provided mentoring and coaching to new associates to facilitate their development and accelerate team growth.• Contributed to assigned special projects including Buy and Bill reports and played a key role in updating SOPs (Standard Operating Procedures) and Job Aids in response to process updates initiated by the client. Show less • Verified medical and pharmaceutical insurance benefits with CMS Medicare, Medicaid, and/or private commercial insurance providers utilizing ICD-9/ICD-10 codes for Abbvie Pharmaceuticals• Aided physician office staff and patients to complete and submit all necessary insurance forms and program applications.• Finalized and submitted all necessary insurance forms and electronic claims for timely payment.• Maintained frequent phone contact with provider representatives, third-party customer service representatives, pharmacy staff, and case managers.• Compiled prior authorization forms, clinical notes, and letters of medical necessity for approval.• Triaged patient prescriptions to designated specialty pharmacies. Show less

  • Case Manager

    Dec 2022 - now

  • Program Coordinator

    Nov 2018 - Dec 2022

  • Benefits Specialist

    Oct 2016 - Nov 2018