Erik D. Tolsma, C.P.C.
1800 Emerywood Lane, Charlotte, NC 28210
(704) 236-0922
ertolsma@gmail.com
EXPERIENCE
Xcenda, LLC
Manager, Reimbursement Strategy & Commercialization, 2007-2008
- Worked closely with clients to develop strong business strategies for navigating the reimbursement landscape.
- Exercised policy analysis and research, strategy development and tactical implementation for medical devices and physician-administered and oral drug products.
- Identified ways of supporting client product needs by understanding public and private policy implications.
- Conducted strategic reimbursement assessments for products including payer mix profiling, Medicare and private payer analysis, competitor review, and strategic recommendations.
- Provided coding analysis and strategy for products including formulation of coding strategy, application for new codes, and creation of materials to support providers, payers, and patients.
- Interacted with managed care plan medical and pharmacy directors to better understand private commercial coverage of unique products.
Lash Group Healthcare Consultants
Program Manager, 2003-2007
- Managed two teams of reimbursement counselors supporting eleven complex reimbursement and patient assistance programs to assist utilization of medical devices and physician-administered pharmaceutical products.
- Served as office resource expert for reimbursement and coding across diverse product specialties.
- Developed strategies to proactively address quality issues and support implementation of improvement processes.
- Identified product reimbursement issues on a payer-specific level by monitoring payer coverage policies.
- Led development of new reimbursement support programs, managing multiple tasks along a parallel process.
- Authored reimbursement updates detailing changes in Medicare proposed and final rules, including both general overviews and client-specific impact analysis.
Lash Group Healthcare Consultants
Senior Reimbursement Counselor, 2002 to 2003
- Supported reimbursement and patient assistance programs ensuring patient access to medical devices, DME, and rheumatology and dermatology pharmaceutical products.
- Assessed and facilitated patient-specific coverage for products and services, navigating coverage obstacles when necessary.
- Developed and updated product-specific billing guides and fact sheets for distribution to healthcare providers.
Kaiser Permanente
Quality Assessment, Improvement, and Reporting Assistant, 2001
- Member of quality assurance team preparing materials and reviewing and organizing documentation in preparation for triennial National Committee on Quality Assurance ten-point accreditation site visit.
- Recorded, coded, and assisted in analysis for medical office patient wait-time study.
SKILLS
- Proficient in Microsoft Office applications
- Command of coding systems (HCPCS, ICD-9, CPT) and payment methodologies (e.g., APC, Fee Schedule)
- Adept at training and explanation of complex reimbursement topics
EDUCATION/CERTIFICATION
Davidson College Davidson, NC
Bachelor of Arts in Psychology, 2000
American Academy of Professional Coders Charlotte, NC
Certified Professional Coder, 2004