Payer, Access, and Telemedicine Operations
Reimbursement, claims, scheduling, clinic coordination, and medical-necessity workflows in patient-facing programs.
BCBSTX reimbursement and workflow design
Context
Payer-supported diabetes programs involving reimbursement, claims, co-pay dynamics, and care coordination.
Evidence
Blue Cross Blue Shield of Texas (BCBSTX), patient recruitment, co-pay strategy, claims processing, and partner evaluation.
Role
- Designed reimbursement and access workflows
- Built claims-processing setup and evaluation logic
- Structured SOPs, partner workflows, and program operations
- Managed co-pay and follow-through dynamics in practice
Televisits, clinic coordination, and medical necessity
Context
Telemedicine programs requiring visit scheduling, clinic participation, and documentation support for patient access.
Evidence
Visit scheduling, televisit coordination, clinic coordination for telemedicine, medical-necessity facilitation, letters to health plan medical directors.
Role
- Coordinated clinics and televisits for patient programs
- Facilitated medical-necessity workflows
- Supported patient letters to health plan medical directors
- Obtained physician signatures and documentation needed for access