Danielle Feist
Pharmacy and Home Infusion Program Officer at Montana Department of Public Health and Human Services- Claim this Profile
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Bio
Credentials
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Registered Health Information Technician (RHIT)
AHIMAMay, 2015- Nov, 2024 -
Certified Pharmacy Technician (CPhT)
Pharmacy Technician Certification Board (PTCB)Oct, 2008- Nov, 2024
Experience
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Montana Department of Public Health and Human Services
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Pharmacy and Home Infusion Program Officer
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Feb 2017 - Present
• Create, implement, and direct program health benefit coverage and reimbursement procedures for 250,000 members based on state and federal Medicaid requirements, Administrative Rules of Montana (ARM), State Plan, and other regulations• Write and update administrative rules, statutes, and policies concerning: outpatient pharmacy and home infusion therapy payment methodology; pharmacy and infusion therapy billing; coding, and administration of benefits; and payment of services totaling over $250M• Strictly monitor tens of thousands of dollars in program for fraud, waste, and abuse; conducting preliminary investigations and report suspected violations in accordance with federal and state statutes and regulations• Author, award, monitor, and enforce multiple requests for proposals (RFPs), contracts, and contract amendments through collaborative negotiation with strong attention to detail for quality patient centered care• Manage processes and disputes addressing coverage, eligibility, reimbursement, and billing with members and providers• Often assigned as acting Bureau Chief facilitating the completion of division requests, resolution of constituent complaints, among other management responsibilities• Led the bureau’s pharmacy team to update the Hepatitis C coverage criteria to provide better treatment access gaining national recognition of state Medicaid agencies from an F score to an A- Show less
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Durable Medical Equipment (DME), Audiology, and Hearing Aid Program Officer
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Oct 2015 - Feb 2017
• Formulated and implemented benefit coverage and reimbursement policy, while maintaining a network of service providers to ensure member access to services • Compiled and published approved Provider Notices, Administrative Rules, and State Plan Amendments (SPA) • Maintained medical coding system with Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT), and International Classification of Diseases (ICD); updating the system with new procedure codes • Assisted the Surveillance and Utilization Review Unit (SURS) to determine potential overpayments and participated in dozens of administrative reviews and fair hearings as a department expert witness • Coordinated and implemented Medicare coverage criteria and reimbursement • Communicated with contractor, both formally and informally, to ensure proper processes and procedures were upheld • Provided help to dozens of providers and members daily regarding coverage, reimbursement, and eligibility issues Show less
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Drug Rebate Specialist
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Feb 2015 - Oct 2015
• Resolved manufacturer disputes by verifying billing information was complete and accurate • Performed claims resolution and analysis, internally and with providers, to verify and correct inaccurate billing information • Co-managed over $100M in drug rebate accounts receivable through timely invoicing, audits, and payment posting• Adhered to and implemented State and Federal rebate policies and procedures • Verified and maintained the automated drug rebate system • Completed claim and invoice audits to ensure accurate rebates were collected Show less
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St. Peter's Health
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United States
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Hospitals and Health Care
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200 - 300 Employee
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Certified Pharmacy Technician
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Aug 2009 - Sep 2020
• Compound IV solutions, including chemotherapy and home infusion therapy • Troubleshoot inventory and medication discrepancies within the secure vault and automatic dispensing machines to ensure reliable controls • Fill and dispense outpatient and inpatient medications • Bill(ed) for medications and/or supplies used between internal departments and outside facilities • Perform(ed) medication audits for the entire facility to ensure secure and accurate quality control • Order(ed) medications and manage(d) inventories through a multitude of distributors and software systems • Contribute(d) to the Patient Assistance Program by qualifying low-income patients for assistance with obtaining medically necessary, high-cost drugs Show less
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Walgreens
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United States
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Retail
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700 & Above Employee
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Certified Pharmacy Technician
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Jun 2004 - Jul 2009
• Processed insurance claims and resolved issues associated with claims in a timely and customer-focused manner • Managed Durable Medical Equipment (DME) claims, written and electronically • Received and completed written prescriptions or refill requests and verified information to ensure accuracy • Pre-packed bulk medicines, filled bottles with prescribed medications, and typed and affixed labels • Answered telephones to promptly respond to customer questions and requests • Assisted customers by answering questions, locating items, and referring them to the pharmacist for medication education • Established and maintained patient profiles with strict confidentiality Show less
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Education
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2012 - 2015
DeVry University
Associate of Applied Science (A.A.S.), Health Information Technology -
2021 -
Western Governors University
Bachelor of Science (B.S.) Business Administration, Healthcare Management
Community
