Experience

Pharmacy Data Management, Inc. (PDMI)

• United States
• Pharmaceutical Manufacturing
• 100 - 200 Employee

• Product Delivery Manager

  • May 2021 - Present

  • Requires full knowledge of client-specific plan designs and benefit structures across all lines of client’s business • Provide leadership and support for the implementation of new client business and ongoing maintenance of existing client business • Provide leadership and support internally to junior staff members; train new hires • Last line for troubleshooting of claims related inquiries, accumulator related inquiries, etc., that cannot be fielded by junior staff members prior to escalation to management staff • Work closely with account management to provide support and assist in meeting client needs and help to determine possible solutions to client requests • Work closely with Transaction Team to develop client-specific and broad company IT solutions • Gather all relevant client documentation and facilitate internal resources on a project basis Show less



Coldwell Banker EvenBay Real Estate

• United States
• Real Estate
• 1 - 100 Employee

• Realtor

  • Apr 2017 - Present

  - Provide guidance and assist sellers and buyers in marketing and purchasing property for the right price under the best terms -Determine clients’ needs and financials abilities to propose solutions that suit them -Intermediate negotiation processes, consult clients on market conditions, prices, mortgages, legal requirements and related matters, ensuring a fair and honest dealing -Perform comparative market analysis to estimate properties’ value -Display and market real property to possible buyers -Maintain and update listings of available properties -Cooperate with appraisers, escrow companies, lenders and home inspectors -Develop networks and cooperate with attorneys, mortgage lenders and contractors -Promote sales through advertisements, open houses and listing services -Remain knowledgeable about real estate markets and best practices Show less



Abarca Health

• United States
• Hospitals and Health Care
• 400 - 500 Employee

• Benefit Administration Analyst

  • Sep 2019 - May 2021

  •Process benefit plan setup for new Medicare, Commercial and Employer client implementations, and also process benefit changes for existing clients. •Monitor and analyze key data and procedures for proper claims processing and adjudication system functionality (i.e. eligibility management, benefit setup) for all clients. •Perform Quality Control and Quality Assurance functions to assess information accuracy in all Benefit Administration processes. •Provide timely support to other areas to verify and analyze claims processing cases, eligibility and other operational situations and/or issues referred for validation. •Support urgent adjudication and processing issues including doing research, analysis, identification of root cause, impact analysis determination and corrective action. •Work cross-functionally to properly carry out changes, evaluate impact of new system requirements and assist in the design and execution of test scripts. •Help gather proper and accurate documentation and data during internal and external audits related to the Company’s PBM processes. •Process Drug Reimbursement requests (DMRs) for Commercial and Employer clients. •Manage the entire EOBs process for Medicare Part D and commercial clients, and ensure timely generation, validation and mailing. Also responsible for EOBs’ Quality Assurance. •Support Plan Finder file submissions by providing analysis and notifying in regards to any corrective action against potential issues. •Develop process documentation, including Policies and Procedures, to document Benefit Administration operational processes. •Stay current with Medicare Part D guidelines in order to make timely adjustments to operations ensuring our processes are in compliance with Medicare Part D’s rules and regulations. •Evaluate and analyze Benefit Administration process requirements to make recommendations for improvements. Show less



Pharmacy Data Management, Inc. (PDMI)

• United States
• Pharmaceutical Manufacturing
• 100 - 200 Employee

• Product Specialist

  • Jun 2017 - Sep 2019

  • System Enrollment and Implementation processes, including -- System set-up; Sponsor set-up; Administrative invoicing and payment procedures• Day-to-day set-up and ongoing maintenance (i.e., changes, updates, etc), including: Benefit code enrollment; Plan design changes; Copayment structures; Admin Fee changes; Network applications; Generic Table maintenance; Special edits that require programming• Quarterly GPI updates• Maintenance of client documentation; coordination of all client-related tasks / projects• Internal support / client liaison for other departments within PDMI, including: first line for helpdesk calls and questions specific to line of business expertise, when applicable, and escalation path for general inquiries Product Delivery Level 1 cannot field• Must be able to effectively communicate with clients• Second line troubleshooting of claims related inquiries, accumulator related Show less

• Product Manager

  • Aug 2015 - Jun 2017

  • Requires full knowledge of client-specific plan designs and benefit structures across all lines of client’s business• Provide leadership and support for the implementation of new client business and ongoing maintenance of existing client business• Provide leadership and support internally to junior staff members; train new hires• Last line for troubleshooting of claims related inquiries, accumulator related inquiries, etc., that cannot be fielded by junior staff members prior to escalation to management staff• Work closely with account management to provide support and assist in meeting client needs and help to determine possible solutions to client requests• Work closely with Transaction Team to develop client-specific and broad company IT solutions• Gather all relevant client documentation and facilitate internal resources on a project basis Show less

• Account Manager

  • Sep 2013 - Aug 2015

  • Manage the entire client relationship to ensure that all client needs are met or exceeded• Coordinate implementation process for new customers within client account• Administer day-to-day client-facing operations, including operational meetings, site visits, and quarterly reviews• Become familiar with client’s service-level agreement; gain thorough understanding of client expectations and service levels• Escalation of client request and items that may fall outside of the contract agreement• Build trust (rapport) with client by learning full scope of client’s business• Coordinate necessary internal resources during implementation process and beyond Show less

• Benefits Analyst

  • Aug 2011 - Sep 2013

  • Ensure accurate and timely installation of new benefit plans and plan benefit changes• Document and complete paperwork for plan changes and quality check once updated• Educate pharmacy and member helpdesk in new plan design and problem resolution• Assist, as needed, in development of installation timeline

• Call Center Agent

  • Feb 2009 - Aug 2011

  ● Responsible for assisting clients with prescription billing and claims processing. ● Facilitate efficient running of services ensuring that procedures relating to good dispensary practice are followed. ● Primary duties included maintaining patient and customer electronic health records.● Strategically troubleshoot claims processed incorrectly and insurance verification.



Option Care Health

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

• Pharmacy Technician

  • Sep 2008 - Jan 2009

  ● Accountable for preparing intravenous, TPN, and chemotherapy prescriptions. ● Coordinated and maintained home infusion services on a regular basis. ● Assisted pharmacists in managing and organizing the workload and maintaining database of drugs used and supplies. ● Accountable for preparing intravenous, TPN, and chemotherapy prescriptions. ● Coordinated and maintained home infusion services on a regular basis. ● Assisted pharmacists in managing and organizing the workload and maintaining database of drugs used and supplies.



CVS Pharmacy

• United States
• Pharmaceutical Manufacturing
• 700 & Above Employee

• Pharmacy Technician

  • Apr 2007 - Sep 2008

  ● Highly effective customer service and communication skills. ● Ability to lead others in a high demand situation by prioritizing and delegating the workload during busy periods. ● Persistent in troubleshooting a wide range of issues with critical thinking, insurance verification and processed claims. ● Highly effective customer service and communication skills. ● Ability to lead others in a high demand situation by prioritizing and delegating the workload during busy periods. ● Persistent in troubleshooting a wide range of issues with critical thinking, insurance verification and processed claims.