Kelvin Rodríguez Reyes, PTCB CPhT
Clinical Specialist II - Formulary Management at PharmPix Corp- Claim this Profile
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Topline Score
Bio
Credentials
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PTCB Certified Pharmacy Technician
Pharmacy Technician Certification Board (PTCB)Feb, 2022- Nov, 2024
Experience
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PharmPix Corp
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United States
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Wellness and Fitness Services
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1 - 100 Employee
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Clinical Specialist II - Formulary Management
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Jul 2021 - Present
Leads Pharmacy Technicians in management of commercial formularies. Serves as a Team Leader for the management, coding and weekly analysis of new drugs to update the formularies. Participates with the P&T committee for strategic formulary management. Propose for training and evaluation initiatives as well as successful implementation of formularies.
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Senior Formulary Management Specialist
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Jan 2016 - Jul 2021
Managed multiple commercial formularies for weekly updates and regular P&T updates. Coding of drug lists and managing other coding projects. Performed analyses for formularies using both Microsoft Excel and Microsoft Access. Update of the MAC lists.
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Implementation Specialist
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Oct 2015 - Jan 2016
Implement co-payment structures, create patient records, create formularies for our clients.Assist in the collection and consolidation of required information and data.Masters data banks used by PharmPix like Medispan and NCPDP, etc.Ensure that all rejected and paid claims are adjudicated and/or rejected as specified by the client and/or PharmPix policies and procedures (Internal Audits).Clients implementations including but not limited to: meetings, communications and tests.Accurately add benefit rules set, contracted networks, copayment rules set, DUR rules set and all necessary information into CUBE in order to assure an implementation set up error <1%.Perform testing to ensure benefits, dur rules, copayment rules and formulary are implemented correctly as stipulated by client. Perform testing to ensure reimbursements to pharmacies are adjudicating in accordance with the network contract.Support all Quality Management Program initiatives. Ability to manage multiple projects at any given time. Show less
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Triple-S
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United States
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Insurance
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700 & Above Employee
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Pharmacy Call Center Supervisor
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Oct 2012 - Oct 2015
Oversee a team of Call Center Representatives as they provide world class customer service to customers by answering questions, resolving issues and assisting with pharmacy transactions. Monitor the quality of the work as your team provides (effective dates of coverage, claims history, deductible and coinsurance amounts, and general benefit information) Cross train in different areas to expand knowledge base and develop new skills. Oversee a team of Call Center Representatives as they provide world class customer service to customers by answering questions, resolving issues and assisting with pharmacy transactions. Monitor the quality of the work as your team provides (effective dates of coverage, claims history, deductible and coinsurance amounts, and general benefit information) Cross train in different areas to expand knowledge base and develop new skills.
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MC-21
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Caguas, Puerto Rico
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Prior Authorization Specialist
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Jan 2007 - Dec 2011
The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question. Contacts plans to extend authorization dates and urgent/priority authorizations/pre-certifications, as needed. Provide Medication Therapy Management (MTM) services through screening of incoming calls to the MTM hotline, monitoring the fax line for responses from the prescribing physician and completion of failed faxes, supporting the pharmacist to complete Comprehensive Medication Reviews (CMRs) through prework and case preparation, communicates with network pharmacies, prescribers, and beneficiaries to provide MTM services. Collaborates with other departments, clinics, and procedures areas to assist in obtaining authorization. Manage pre-authorizations according to the necessary requirements for Commercial and Medicare coverage. Show less
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Droguería Betances, Inc.
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United States
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Wholesale
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1 - 100 Employee
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Pharmacy Technician
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Sep 2006 - Dec 2006
This position involves speaking and selling drug purchase orders to pharmacies on a daily basis to ensure they have up-to-date inventory. Review sell orders and assess the profitability of the sell side. Review pending outbound sales orders in the queue and assess profitability from both a line item and total order point of view. This position involves speaking and selling drug purchase orders to pharmacies on a daily basis to ensure they have up-to-date inventory. Review sell orders and assess the profitability of the sell side. Review pending outbound sales orders in the queue and assess profitability from both a line item and total order point of view.
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Farmacia Profesional
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Caguas, Puerto Rico
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Pharmacy Technician
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Apr 2004 - Sep 2006
Accurately assists the Pharmacist in all duties pertaining to the medication distribution. I knew the duties and general processes of the Pharmacy department. Successfully complete role based training requirements, including passing certifications and competency. Accurately assists the Pharmacist in all duties pertaining to the medication distribution. I knew the duties and general processes of the Pharmacy department. Successfully complete role based training requirements, including passing certifications and competency.
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Education
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Inter-American University of Puerto Rico - Metropolitan Campus
Natural Sciences -
Huertas College
Pharmacy Technician/Assistant
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