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Skills

  • Team management
  • Budgets
  • Insurance billing dispute resolution
  • Claims adjudication
  • Network expansion with pharmacies
  • Cost-benefit analysis
  • Workflow improvements
  • Organization
  • Supervision
  • Data-driven decision making

Work Experiences

  • Communicated remediation strategies to third-party payers.
  • Collaborated with pharmacists to resolve unplanned changes in formularies, ensuring members received timely alternatives, reducing disruption by 55% %.
  • Transported Jira to one year customer locations.
  • Accelerated the prior authorization process for high-cost medications.
  • Actively participated in pharmaceutical and insurance audits, ensuring 100% compliance with framework for 7 consecutive years.
  • Achieved overall cost reduction of $6.
  • Recommend successful approaches to Prescription Benefit Specialist for resolving salary and classification complaints.
  • Actively participated in pharmaceutical audits.
  • Oversaw the delivery of system project by method team, which resulted in procedure.
  • Saved $4 by putting in place cost-cutting measures that addressed long-standing issues.

Summaries

  • Collaborative Prescription Benefit Specialist known for enhancing formulary understanding by developing training materials that lowered call center support requests by 31% %.
  • Advanced expertise in providing pharmacy benefit system support, reducing system downtime by 24% hours monthly through timely technical interventions.
  • Achieved a 43% reduction in service inquiries.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Bolstered member awareness of benefit programs.
  • Miscellaneous systems, compensation strategies, and benefit packages are all familiar to me.
  • To categorize positions, successfully gather and evaluate information, interview employees, and assess occupational information.
  • Consistently exceeded service targets.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved measurable success in reducing claims denials by 19%.

Accomplishments

  • Streamlined the process for verifying member benefit eligibility, reducing wait times for both customers and pharmacies by an average of 4 minutes.
  • Provided guidance to members on their prescription benefits, increasing customer satisfaction ratings by 56% through targeted communication efforts.
  • Trained 12 new hires on prescription benefits processing procedures, improving team accuracy and proficiency by 78%.
  • Overhauled the prior authorization process, reducing approval timeframes by 79% and enhancing overall service delivery to affected members.
  • Coordinated with third-party benefit providers to resolve issues for over 15 members monthly, improving claim accuracy rates by 63%.
  • Developed and delivered training sessions on best practices for formulary management, improving team adherence to standards and reducing claim errors by 18%.
  • Developed a new appeals process that successfully overturned 59% of denied claims, generating increased member satisfaction and preserving $16 in revenue.
  • Reduced cost discrepancies in prescription drug claims by 66% by providing real-time support and clarification to pharmacy networks.
  • Successfully navigated complex third-party insurance laws, resulting in the approval of 2 previously denied medication claims.
  • Designed and implemented a member communication campaign that led to a 23% increase in member awareness regarding benefit coverage for specialty medications.

Affiliations

  • National Alliance of State Pharmacy Associations (NASPA)
  • Academy of Managed Care Pharmacy (AMCP)
  • Freemason
  • National Society of Certified Healthcare Business Consultants (NSCHBC)
  • International Association of Administrative Professionals
  • Pharmacy Technician Certification Board (PTCB)
  • American Academy of Professional Coders (AAPC)
  • Project Management Institute
  • Lions Club
  • Pharmacy Quality Alliance (PQA)

Certifications

  • Certified Prescription Drug Plan Specialist - Vantage
  • Cisco Certified Network Associate (CCNA)
  • Certification in Call Center Customer Service Skills - Brightline
  • Professional in Medicare Claims Certification (PMCC) - Northwind
  • CompTIA Network+
  • SHRM Certified Professional (SHRM-CP)
  • Certificate in Utilization Management (UM) - Brightline
  • First Aid/CPR Certified
  • AAPC Certified Professional Coder (CPC) - Vantage
  • Salesforce

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