Experience

• 

  Prescryptive Health

  • Pharmacy Benefit Analyst

• 

  Prescryptive Health, Inc.

  • United States

  • Pharmacy Benefit Analyst

    • Aug 2020 - Feb 2024
    • United States

• 

  Premera Blue Cross

  • United States
  • Insurance
  • 700 & Above Employee

  • Pharmacy Compliance Specialist

    • Jun 2016 - Jul 2020

    • Provide formulary drug list support with development, maintenance,quality control checks, auditing, and upkeep of formulary websitedisplay to ensure a positive and accurate customer experience.• Consult with pharmacists to prepare submission of formulary druglists to Alaska, Oregon, Washington states and Centers for Medicareand Medicaid Services (CMS) for the Affordable Care Act (ACA).• Oversee pharmacy performance on National Committee for QualityAssurance (NCQA) standards, as well as create and maintain internalpolicies and procedures to meet requirements.• Effectively collaborate with internal departments across Premeraand external partners.• Primary contact regarding formulary drug list gaps and support withidentifying root cause and corrective action.• Create, analyze, and provide recommendations to stakeholders onmember impact reports.

  • Pharmacy Services Specialist II

    • Jun 2014 - Jun 2016

    Provided administrative oversight of formulary drug lists including upkeep of pharmacy drug list websites to ensure accuracy.Supported specialty pharmacy program with contracts, coordination of communication and education, and identifying escalated member priorities with our specialty pharmacy partners. Served as main resource for pharmacy operational gaps and worked with supporting internal and external areas in identifying root cause, and implementation of corrective and preventive action.Provided training and support for newly hired Pharmacy Services Specialist I.

  • Pharmacy Services Specialist I

    • Feb 2012 - Jun 2014

    Effectively and efficiently interacted with customers, physicians, nurses and office staff via phone, e-mail, and fax. Supported Pharmacy Prior Authorization Program by performing level I review for exception requests according to set clinical criteria and medical policies.Determined customer eligibility, verification and interpretation of pharmacy benefits.Accurately processed, entered, documented and initiated notifications on prior authorization requests in Express Scripts Client and C‐360 program.

• 

  Bartell Drugs

  • Pharmacy Technician

    • Nov 2002 - Feb 2012

    Performed data entry of patient information, third‐party information and prescriptions into the McKesson Enterprise system.Productively resolved insurance rejections and other billing issues.Assisted in maintaining accurate inventory and ordering products as needed.Handled recalls, returns and expired products.Assisted pharmacists in preparing compounds and vaccines for onsite travel clinic.Provided excellent customer service for pharmacy and retail customers.Primary trainer for company synchronized refill program.Trained new or agency pharmacy technicians and pharmacists on the McKesson Enterprise system.