Ryan Richmond

Background

About Ryan Richmond

Licensed Clinical Social Worker (LCSW): Master’s Degree of Social Work (MSW) and 15+ years of professional experience working in the healthcare industry. Experience has included providing direct patient care, performing training and consultation services, delivering intensive case management, conducting quality assurance/improvement initiatives, and working in leadership/managerial roles.*Experience managing an assigned territory and providing product-specific, medical-benefit reimbursement support and assistance (including utilization and application of approved tools and resources) to specialty health care providers and large multi-site healthcare systems. Assisting health care providers and patients work through reimbursement barriers and understand the regional and national payer landscape, including review of payer coverage policies. Consultation experience related to all aspects of the buy-and-bill reimbursement cycle.*Experience in training, consulting, and collaborating with internal Sales, Marketing, Managed Markets, Legal/Compliance/Regulatory, as well as external stakeholders, such as patients, healthcare billing administrative staff, and providers. Experience in facilitating physician speaker programs, as well as leading reimbursement-focused meetings and trainings.*Experience with billing/coding of physician-administered injectables, including miscellaneous and permanent J-codes, and Category I and CPT codes. Expereincing in supporting accounts in staying current with and understanding industry trends and best practices/considerations. Assisting clinical and administrative staff with claims review/reimbursement analysis, use of modifiers, procedure-to-procedure edits, etc.*Consultation with claims submission process and coordinating reimbursement cycle support/workflow processes across different places of service, including physician office (11), ASC (24), and HOPD (22) settings.*Extensive case management of and support with benefits verifications, prior authorizations, appeals and denials in collaboration with provider groups and internal/external patient assistance programs.*Expertise in drug acquisition models, including Buy & Bill (B&B) and Specialty Pharmacy (SP) procurement channels.*Product launch experience, as well as knowledge of presenting drug-specific clinical information and reporting of potential adverse events.*Experience with Customer Relationship Manager (CRM) software, including Salesforce programs.