Experience

Valley Health Plan

• United States
• Insurance
• 100 - 200 Employee

• Management Analyst

  • Apr 2022 - Present

  • Demonstrate expertise serving as a Super User and SME for Epic implementation utilizing robust knowledge and understanding of methods for designing and developing Epic systems. • Create and establish design corporations, divisions, and employer groups which determine the source of member eligibility and benefits in the health plan. • Configure Epic Tapestry systems Eligibility and Enrollment functionality as well as design, test, and validate inbound and outbound eligibility files… Show more • Demonstrate expertise serving as a Super User and SME for Epic implementation utilizing robust knowledge and understanding of methods for designing and developing Epic systems. • Create and establish design corporations, divisions, and employer groups which determine the source of member eligibility and benefits in the health plan. • Configure Epic Tapestry systems Eligibility and Enrollment functionality as well as design, test, and validate inbound and outbound eligibility files, including golden flat file and conversion files. • Originate rules to identify members for a multitude of letters and automate processes for generating letters for the identified members. • Implement key system processes within Epic Tapestry, such as ID card and letter generation, when members meet certain criteria. • Investigate, analyze, and resolve critical issues with premium billing and invoices not being generated or generating as $0 instead of the correct premium. • Participate actively in Epic Workgroups alongside account managers to identify trouble areas and ways to resolve these issues. • Attend Epic Workgroups with builders to provide insight on current workflows and how to engineer the design to achieve company goals. • Study and assess documents, such as health plans, Business Requirement Documents (BRDs), and vendor system builds, and provide analysis and suggestions to the build team.

• Associate Management Analyst

  • Sep 2019 - Apr 2022

  • Ascertained issues within programs/systems and provided advisement on effectively resolving issues by testing and validating potential fixes. • Assessed current, new, and proposed workflows and processes with the goal of enhancing efficiency within the department. • Reviewed and reconciled 207k+ members’ health plan data with Covered California state, Santa Clara County, and Medi-Cal data, by addressing issues using Excel functions, formulas, and pivot tables. • Cross-collaborated… Show more • Ascertained issues within programs/systems and provided advisement on effectively resolving issues by testing and validating potential fixes. • Assessed current, new, and proposed workflows and processes with the goal of enhancing efficiency within the department. • Reviewed and reconciled 207k+ members’ health plan data with Covered California state, Santa Clara County, and Medi-Cal data, by addressing issues using Excel functions, formulas, and pivot tables. • Cross-collaborated with Finance, Pharmacy, Information Systems, and Compliance teams to discuss, validate, and execute policies for regulatory compliance. • Partnered with external vendors to develop and implement system upgrades, including identifying issues within the current system, creating test plans, validating fixes, and implementing updates. • Worked with interdisciplinary teams to manage data in accordance with business rule documents (BRD's) and troubleshoot issues with the eligibility and finance interfaces. • Trained and guided new staff on enrollment and finance operations, billing functionality, and eligibility issues and reconciliation processes. • Executed large-scale projects in collaboration with compliance teams regarding new requirements of DMHC and State/Federal regulations. • Headed the conversion from flat files to 834 file formats and implemented nine letter interfaces with Clarity. • Established specifications for compiling and querying data required for report analysis. • Formulated Microsoft Access database file conversion for County of Santa Clara Commercial Preferred enrollments.

• Pharmacy Data Specialist

  • Aug 2016 - Sep 2019

  • Spearheaded all phases of the Pharmacy SharePoint 2013 implementation and conducted data mapping and validation for the MedInsight database warehouse. • Developed reporting functions and tools as requested by management and updated Business Requirement Documents (BRD’s). • Integrated efficient clerical procedures and key policies concerning eligibility, analytical reports, auditing, and accreditation. • Reviewed documents for compliance with policies and regulations for the… Show more • Spearheaded all phases of the Pharmacy SharePoint 2013 implementation and conducted data mapping and validation for the MedInsight database warehouse. • Developed reporting functions and tools as requested by management and updated Business Requirement Documents (BRD’s). • Integrated efficient clerical procedures and key policies concerning eligibility, analytical reports, auditing, and accreditation. • Reviewed documents for compliance with policies and regulations for the Department of Managed Health Care, Affordable Care Act, NCQA, and AAAHC accreditation. • Examined data involving variables that required discretion or informed judgment for correction of eligibility issues, financial reconciliation, and medication utilization.



Santa Clara Valley Medical Center

• United States
• Hospitals and Health Care
• 700 & Above Employee

• INPATIENT PHARMACY TECHNICIAN

  • Oct 2011 - Aug 2016

  • Created, tracked, and maintained accurate records of controlled substance medications within all floor units. • Configured, deployed, upgraded, and supported Pyxis systems as well as monitored Pyxis Network communication and implemented measures to minimize Pyxis downtime. • Ensured appropriate supplies were on hand for the inpatient pharmacy to complete duties, such as compounding, IV preparation, medication dispensing, and prepacking. • Installed, loaded, and corrected issues with… Show more • Created, tracked, and maintained accurate records of controlled substance medications within all floor units. • Configured, deployed, upgraded, and supported Pyxis systems as well as monitored Pyxis Network communication and implemented measures to minimize Pyxis downtime. • Ensured appropriate supplies were on hand for the inpatient pharmacy to complete duties, such as compounding, IV preparation, medication dispensing, and prepacking. • Installed, loaded, and corrected issues with Pyxis Machines and updated the Pyxis access database. • Maintained narcotic discrepancy records and followed-up with staff to confirm resolution. • Designed, installed, and managed the Baxter Exactamix TPN compounding system. • Synthesized, scrutinized, and translated data from multiple sources, such as Pyxis, Cardinal, and Healthlink and utilized data to create concise and accurate reports. • Generated reports on cost savings of alternate drugs and presented them to management for approval. • Certified full compliance with sterilization protocols in the IV room in accordance with regulatory agency recommendations. • Ensured compliance with regulations set by the Board of Pharmacy and JCAHO prior to audits to ensure audits were passed. Show less • Created, tracked, and maintained accurate records of controlled substance medications within all floor units. • Configured, deployed, upgraded, and supported Pyxis systems as well as monitored Pyxis Network communication and implemented measures to minimize Pyxis downtime. • Ensured appropriate supplies were on hand for the inpatient pharmacy to complete duties, such as compounding, IV preparation, medication dispensing, and prepacking. • Installed, loaded, and corrected issues with… Show more • Created, tracked, and maintained accurate records of controlled substance medications within all floor units. • Configured, deployed, upgraded, and supported Pyxis systems as well as monitored Pyxis Network communication and implemented measures to minimize Pyxis downtime. • Ensured appropriate supplies were on hand for the inpatient pharmacy to complete duties, such as compounding, IV preparation, medication dispensing, and prepacking. • Installed, loaded, and corrected issues with Pyxis Machines and updated the Pyxis access database. • Maintained narcotic discrepancy records and followed-up with staff to confirm resolution. • Designed, installed, and managed the Baxter Exactamix TPN compounding system. • Synthesized, scrutinized, and translated data from multiple sources, such as Pyxis, Cardinal, and Healthlink and utilized data to create concise and accurate reports. • Generated reports on cost savings of alternate drugs and presented them to management for approval. • Certified full compliance with sterilization protocols in the IV room in accordance with regulatory agency recommendations. • Ensured compliance with regulations set by the Board of Pharmacy and JCAHO prior to audits to ensure audits were passed. Show less



Walgreens

• United States
• Retail
• 700 & Above Employee

• Senior Certified Pharmacy Technician

  • Jul 2010 - Jan 2016

  • Delivered comprehensive reports concerning cost savings and losses for expired, overstock, and recalled medications to the pharmacy and store managers. • Oversaw new Pharmacy Technicians, Managers, and Pharmacist Interns, delegated tasks, and trained all staff in pharmacy related duties. • Ensured strict compliance with Board of Pharmacy and Drug Enforcement Agency rules and regulations. • Acquired data from internal systems and Cardinal websites in order to create analytic reports… Show more • Delivered comprehensive reports concerning cost savings and losses for expired, overstock, and recalled medications to the pharmacy and store managers. • Oversaw new Pharmacy Technicians, Managers, and Pharmacist Interns, delegated tasks, and trained all staff in pharmacy related duties. • Ensured strict compliance with Board of Pharmacy and Drug Enforcement Agency rules and regulations. • Acquired data from internal systems and Cardinal websites in order to create analytic reports with recommendations for decreasing costs. • Delivered keen advisement to the Pharmacy Manager and Store Manager regarding setting limits on medication inventory on hand to decrease overall cost and waste. • Performed user acceptance testing for upgrades to internal prescription processing system, identified bugs in the daily work flow, and worked with IT to resolve roadblocks. • Maintained compliance with HIPAA regulations and guidelines to protect patient privacy. Show less • Delivered comprehensive reports concerning cost savings and losses for expired, overstock, and recalled medications to the pharmacy and store managers. • Oversaw new Pharmacy Technicians, Managers, and Pharmacist Interns, delegated tasks, and trained all staff in pharmacy related duties. • Ensured strict compliance with Board of Pharmacy and Drug Enforcement Agency rules and regulations. • Acquired data from internal systems and Cardinal websites in order to create analytic reports… Show more • Delivered comprehensive reports concerning cost savings and losses for expired, overstock, and recalled medications to the pharmacy and store managers. • Oversaw new Pharmacy Technicians, Managers, and Pharmacist Interns, delegated tasks, and trained all staff in pharmacy related duties. • Ensured strict compliance with Board of Pharmacy and Drug Enforcement Agency rules and regulations. • Acquired data from internal systems and Cardinal websites in order to create analytic reports with recommendations for decreasing costs. • Delivered keen advisement to the Pharmacy Manager and Store Manager regarding setting limits on medication inventory on hand to decrease overall cost and waste. • Performed user acceptance testing for upgrades to internal prescription processing system, identified bugs in the daily work flow, and worked with IT to resolve roadblocks. • Maintained compliance with HIPAA regulations and guidelines to protect patient privacy. Show less