Experience

Catalyst Rx

• Pharmaceutical Manufacturing
• 100 - 200 Employee

• Issue Reconciliation Specialist

  • Sep 1999 - Present

   Analyze potential issues submitted from various departments within Operations and determine if the issue has financial impact to the client or members or with Pharmacy in running queries in Business Objects and doing a full analysis in Excel. The final documentation of the Issue Reconciliation report from Business Objects and identify the cause and effect. The analyst forwards the query request form and impact to the Issue Reconciliation manager or director for final department review. Once all approvals are obtained from Managers, Client Services, and Upper Management the final documentation is submitted to the accounts payable or member claims department to proceed with Payments to Members or Issuing Credits or Refunds to Clients or Pharmacy. Show less

• Issue Reconciliation Specialist

  • 1999 - Present

   Analyze potential issues submitted from various departments within Operations and determine if the issue has financial impact to the client or members or with Pharmacy in running queries in Business Objects and doing a full analysis in Excel. The final documentation of the Issue Reconciliation report from Business Objects and identify the cause and effect. The analyst forwards the query request form and impact to the Issue Reconciliation manager or director for final department review. Once all approvals are obtained from Managers, Client Services, and Upper Management the final documentation is submitted to the accounts payable or member claims department to proceed with Payments to Members or Issuing Credits or Refunds to Clients or Pharmacy. Show less



Walgreens

• United States
• Retail
• 700 & Above Employee

• Benefits Specialist

  • May 2004 - Jun 2011

   Liaison between Account Managers and Clients to implement new benefits designs and any updates to the existing client benefit designs  Perform analytical procedures to assess new benefits and/or existing client designs and provide recommended modification plan design in relation to the system capabilities  Responsible for implementing new client’s benefits and/or implementing changes to existing clients but not limited to formularies, copay, contractual reimbursement parameters and network arrangements. system  Analyze plan benefits to clarify and resolve all issues relating to setups within the claims processing system.  Create and evaluate Business Objects queries to make sure claims adjudicated properly when the new benefit design or existing client benefit changes were implemented  Create and analytical evaluation of any issues to determine the cause and effect and present the analysis results to the Account Manager  Train employees on the claim processing system as well as day to day standard operation procedures and provide solutions and suggestions to improve general workflow Show less