Mark Berrones

Experience

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  St. Joseph's Hospital and Medical Center

  Jul 2010 - Apr 2013

  Case Manager

  Ensured that all assigned patients obtained financial clearance for services. Collaborate closely with other departments, such as Case Management, physicians, hospitalists and the international concierge to facilitate financial clearance. Interviewed patients to address all missing information and outstanding patient liabilities. Identified patients who may be eligible for government program assistance and referred, as appropriate, for completion of applications. Assisted patients with Dignity Health’s Payment Assistance Program, as well as the state’s Medicaid program (AHCCCS); provided applications, and where necessary, assisted in the completion of that application. Calculated patient liabilities, made payment arrangements and collected monies from patients. Confirmed that signatures are collected on patient Condition of Admission forms. Insurance verifications, authorization and billing processes made. Created flat rate patient agreements for uninsured, underinsured, or non-authorized scheduled patients. Knowledge of APC Calculator, ClearQuote, Craneware, and several online and offline tools used in the creation of estimates, insurance verification, Advanced Beneficiary Notices, and out-of-state Medicaid programs as well as state and federal funded programs such as SSI-MAO and Contract Health Services for coverage. Elected Admitting systems trainer for Cerner implementation during paperless transition for 24/7 departments such as the Emergency Department and OB. Show less

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  Huntington Orthopedic Surgery

  Apr 2013 - Oct 2015

  Revenue Cycle Systems

  Responsible for the day-to-day operations on all issues relating to the revenue-cycle. Job responsibilities, including, but not limited to reviewing collection reports to identify payer and other collection issues, develop and implement practice specific process improvement recommendations to secure positive results, monitor performance and improvements for favorable trends, maintain reimbursement related key performance indicators for network practices, setting and benchmarking revenue cycle goals. Develop and implement practice specific process improvement recommendations to secure positive results, monitor performance and improvements for favorable trends. Monitor and increase reimbursements within practice. Enhance and standardize work-flow processes throughout the revenue cycle to assist in achieving consistency in maintaining cash flow. Format and run impromptu reports as requested. Run Aged Trial Balances for collection focus. Run month end and provider service for management. Develop strategic plans and programs for business office team. Help in reducing costs with the business unit. Update all posting (batches), file transaction journals, review and enter cash and voucher voids. Super User, including security access maintenance. Oversee credentialing process for all providers with Medicare. Show less

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  McKesson

  Oct 2015 - Nov 2016

  Unit Coordinator

  Works in a fast paced, high-volume contact center environment with a variety of product support programs managing complex reimbursement issues. Provides guidance and first line support to pharmacy specialists and reimbursement specialists. Monitors and coordinates workload. Works closely with healthcare providers and patients to assist with escalated reimbursement or order status questions. Must have an in-depth understanding of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits. Must have an in-depth understanding of Medicare, Medicaid, and various public funding programs in order to effectively support the reimbursement specialist. This position operates in a lead capacity when the Reimbursement Supervisor is not available to answer questions and provide guidance to frontline staff. Must have the ability to correctly discern problems following established procedures and determine appropriate course of action. Ability to communicate product benefits and efficacy to positively influence payer policy. Capable of monitoring drug coverage policies for multiple payers. Reviewing case outcomes to analyze and identify payment and denial trends as well as key findings for client reporting. Conducting external research to identify appropriate alternate funding sources for inclusion to the internal resource database for future reference purposes. As well as possess the ability to effectively respond to escalated issues and complex cases referred from other reimbursement employees or manufacturer representatives. Worked on several special client and manager assigned projects to ensure timely and service level agreements for client. Has an understanding of insurance plans and benefit structure along with Medicare and Medicaid programs. Conducts collaborative phone meetings with an on-site patient service liaison on non-patient specific agendas. Show less

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  Xcenda

  Dec 2016 - Sept 2020

  Field Reimbursement Manager

  Currently in hematology-oncology team servicing the Southwest region including Phoenix and greater areas, Los Angeles and greater areas, Albuquerque, El Paso, and Las Vegas. Assist provider offices in resolving complex coverage and reimbursement issues that may create barriers to access for patients. With travel weekly, Monday – Thursday, to healthcare offices within a designated territory, using their knowledge of coverage, patient assistance, and health policy to educate office staff and break through access issues to ultimately help patients. Providing face-to-face, personalized issue resolution. Educating provider offices on local and regional payer issues, coding changes, and appropriate claims submission processes. Liaising with reimbursement hotlines regarding alternative funding/financial assistance programs. Assisting with determining coverage and access options available for a specific medication or procedure. Takes part in national meetings with teams to provide feedback and receive client training and updates. Ordering business cards, patient and office access material to provide to accounts. Takes part in weekly team calls, client colleague, and sales calls for input and updates. Conducts pre-call planning to accounts to schedule office visits to provide efficient and catered visits with contacts. Experience with previous teams in immunology for reimbursement and patient access. Show less

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  GSK

  Oct 2020 - now

  Field Reimbursement Manager

  Supports appropriate patient access to GSK Specialty products. This role is responsible for educating healthcare professionals about important product reimbursement information and processes as well as helping providers understand GSK Access Support Services that may be available to help appropriate patients access GSK specialty medicines. Specialty FRMs are responsible for educating providers on key payer policies related to GSK specialty products and work to communicate the impact of these payer policies on payer access back to the Payer Account Team. This role reports to a Director of Specialty Field Reimbursement. Qualified candidates must possess a demonstrated track record of success working in a matrix environment and must demonstrate effective leadership of non-direct reports. Specialty FRMs routinely interface with Payer Account Managers, Specialty Pharmacy Account Directors and Specialty Sales professional teams. Show less