Experience

creehan & company
• United States
• IT Services and IT Consulting
• 1 - 100 Employee
• Business Analyst

  • 2013 - Present


Inovalon

• United States
• Software Development
• 700 & Above Employee

• Senior Business Analyst

  • 2013 - Jan 2023

  Support Specialty, PBM, and Pharma Clients during implementations and upgrade activities. •Liaise between the Design, Development, Architecture, UI/UX teams and the Client stakeholders to define and communicate business requirements and project objectives •Familiar with Waterfall, Agile Methodologies, MS Office Suite, SQL, VSTS, TEAMS •Aid in system training, user acceptance testing (UAT), issue triage and resolution. ScriptMed™ is a SaaS enterprise application used by… Show more Support Specialty, PBM, and Pharma Clients during implementations and upgrade activities. •Liaise between the Design, Development, Architecture, UI/UX teams and the Client stakeholders to define and communicate business requirements and project objectives •Familiar with Waterfall, Agile Methodologies, MS Office Suite, SQL, VSTS, TEAMS •Aid in system training, user acceptance testing (UAT), issue triage and resolution. ScriptMed™ is a SaaS enterprise application used by Specialty/TMO/Retail pharmacies, PBMs, Payers, and other Healthcare entities. SM technology is used to manage Referral, Clinical, Financial, Pharmacy Operations, Fulfillment, and Reporting activities. •Research and analyze software and processes in order to anticipate business needs and effectively propose and deliver long-term solutions. •Conduct end user and internal training using various online platforms (UAT, Regression, MST). •Track and manage client issues via online platforms (e.g.: Issue Tracker, ALM, TFS, VSTS, and Service Now). Assist in triaging escalated system defects and work to resolve issues. •Assist to define project scopes and create appropriate documentation (BRDs, Change Summaries, Enhancement Requests, LOE/SWAG, SOWs, Design docs). •Create documentation and interactive presentations to demo proof of concepts for recommended enhancements and business need solutions. •Work with IT and Business partners to build SOPs, provide support to manage application SLAs, resolve issues and fulfill service requests that do not require code development (e.g.: system/ database configuration). •Maintain audit records, compliance, certification (e.g.: URAC, EPCS/Surescripts, HIPAA). •Serve as the Client Representative during design handoff meetings and demos from analysis to development and development to QA in the system development life cycle. •Work with design, systems analyst/programmers, DBAs, SMEs and development teams during the technical design, coding, testing and implementation stages. Show less Support Specialty, PBM, and Pharma Clients during implementations and upgrade activities. •Liaise between the Design, Development, Architecture, UI/UX teams and the Client stakeholders to define and communicate business requirements and project objectives •Familiar with Waterfall, Agile Methodologies, MS Office Suite, SQL, VSTS, TEAMS •Aid in system training, user acceptance testing (UAT), issue triage and resolution. ScriptMed™ is a SaaS enterprise application used by… Show more Support Specialty, PBM, and Pharma Clients during implementations and upgrade activities. •Liaise between the Design, Development, Architecture, UI/UX teams and the Client stakeholders to define and communicate business requirements and project objectives •Familiar with Waterfall, Agile Methodologies, MS Office Suite, SQL, VSTS, TEAMS •Aid in system training, user acceptance testing (UAT), issue triage and resolution. ScriptMed™ is a SaaS enterprise application used by Specialty/TMO/Retail pharmacies, PBMs, Payers, and other Healthcare entities. SM technology is used to manage Referral, Clinical, Financial, Pharmacy Operations, Fulfillment, and Reporting activities. •Research and analyze software and processes in order to anticipate business needs and effectively propose and deliver long-term solutions. •Conduct end user and internal training using various online platforms (UAT, Regression, MST). •Track and manage client issues via online platforms (e.g.: Issue Tracker, ALM, TFS, VSTS, and Service Now). Assist in triaging escalated system defects and work to resolve issues. •Assist to define project scopes and create appropriate documentation (BRDs, Change Summaries, Enhancement Requests, LOE/SWAG, SOWs, Design docs). •Create documentation and interactive presentations to demo proof of concepts for recommended enhancements and business need solutions. •Work with IT and Business partners to build SOPs, provide support to manage application SLAs, resolve issues and fulfill service requests that do not require code development (e.g.: system/ database configuration). •Maintain audit records, compliance, certification (e.g.: URAC, EPCS/Surescripts, HIPAA). •Serve as the Client Representative during design handoff meetings and demos from analysis to development and development to QA in the system development life cycle. •Work with design, systems analyst/programmers, DBAs, SMEs and development teams during the technical design, coding, testing and implementation stages. Show less


Summary.
• Germany
• General Experience

  • 1997 - 2017


Benecard PBF

• Pharmaceutical Manufacturing
• 200 - 300 Employee

• Account Manager - Medicare Part D

  • 2012 - 2013

  ▪ Partnered with Directors of Quality Management, Audit and Compliance, IT/QA, and FWA in planning, testing, and implementation of Medicare Part D plans. ▪ Monitored facets of QA/operations to identify gaps and drive process improvement, CMS compliance, and to ensure organizational target goals were met. Reviewed CMS manuals and communications to maintain awareness of compliance standards. ▪ Created QA test data utilized for various types of Med D plan verification (regression testing… Show more ▪ Partnered with Directors of Quality Management, Audit and Compliance, IT/QA, and FWA in planning, testing, and implementation of Medicare Part D plans. ▪ Monitored facets of QA/operations to identify gaps and drive process improvement, CMS compliance, and to ensure organizational target goals were met. Reviewed CMS manuals and communications to maintain awareness of compliance standards. ▪ Created QA test data utilized for various types of Med D plan verification (regression testing, financial audits, etc.). ▪ Managed and assisted with projects focused on Medicare D plan uploads, updates, testing, and auditing (B&R/TrOOP/Reconciliation/Wrap Coverage/P&Ps/etc.). ▪ Provided high levels of collaborative support in various departments as needed (IT, Acct Management, Ops, Customer Svc.) Show less ▪ Partnered with Directors of Quality Management, Audit and Compliance, IT/QA, and FWA in planning, testing, and implementation of Medicare Part D plans. ▪ Monitored facets of QA/operations to identify gaps and drive process improvement, CMS compliance, and to ensure organizational target goals were met. Reviewed CMS manuals and communications to maintain awareness of compliance standards. ▪ Created QA test data utilized for various types of Med D plan verification (regression testing… Show more ▪ Partnered with Directors of Quality Management, Audit and Compliance, IT/QA, and FWA in planning, testing, and implementation of Medicare Part D plans. ▪ Monitored facets of QA/operations to identify gaps and drive process improvement, CMS compliance, and to ensure organizational target goals were met. Reviewed CMS manuals and communications to maintain awareness of compliance standards. ▪ Created QA test data utilized for various types of Med D plan verification (regression testing, financial audits, etc.). ▪ Managed and assisted with projects focused on Medicare D plan uploads, updates, testing, and auditing (B&R/TrOOP/Reconciliation/Wrap Coverage/P&Ps/etc.). ▪ Provided high levels of collaborative support in various departments as needed (IT, Acct Management, Ops, Customer Svc.) Show less



Express Scripts Inc. / Curascript Specialty Pharmacy

• Quality Assurance Analyst

  • 2008 - 2012

  ▪ Managed all facets of QA to drive improvement in patient care and client relations across the enterprise. ▪ Prepared reports, presentations, and training materials. Trained groups of 100+ adult learners on healthcare-related systems and applications. Praised in reviews for my ability to quickly master and impart complex material (P&Ps/Apps/Software/Processes) in a graspable and retainable language for trainees/team members. ▪ Successfully managed team and independent projects… Show more ▪ Managed all facets of QA to drive improvement in patient care and client relations across the enterprise. ▪ Prepared reports, presentations, and training materials. Trained groups of 100+ adult learners on healthcare-related systems and applications. Praised in reviews for my ability to quickly master and impart complex material (P&Ps/Apps/Software/Processes) in a graspable and retainable language for trainees/team members. ▪ Successfully managed team and independent projects focused on service improvement. ▪ Trained teams on Pharmacy concepts, regulations, PBM processes, provider-specific materials, contract adherence, and UM. ▪ Independently developed and executed SFO team training and improvement strategies. Increased team’s level of service excellence to standards compliant with ACHC requirements and contractual performance goals. Key performance indicators were exceeded and QA stats increased by 30% (2009-2010). ▪ Earned a reputation as a valuable and cooperative coworker by being fair, honest, and quick to proactively help others. ▪ Highly regarded by team for swift problem resolution & developing forward-thinking strategies aimed at long-term success. Attended monthly corporate planning meetings and weekly leadership meetings for management to collaborate in writing, updating, reviewing policies & procedures, provider contracts, performance goals, strategies, current events, business needs, organizational chart changes, and other topics of relevance. ▪ Responsibilities included training & developing teams - entry-level & veteran: PCAs, Clinical RNs, RPhs, B&R reps, CPTs, Account Managers, Social Workers, UM and hub teams dedicated to specialized disease states and limited-distribution drugs (e.g.: Acthar, Synagis, Iressa, PAH, IVIG, Hemophilia, HGH). Tracked progress and completed weekly reviews/reports impacting bonus potential, merit increase, hiring decisions & advancement of trainees. Show less ▪ Managed all facets of QA to drive improvement in patient care and client relations across the enterprise. ▪ Prepared reports, presentations, and training materials. Trained groups of 100+ adult learners on healthcare-related systems and applications. Praised in reviews for my ability to quickly master and impart complex material (P&Ps/Apps/Software/Processes) in a graspable and retainable language for trainees/team members. ▪ Successfully managed team and independent projects… Show more ▪ Managed all facets of QA to drive improvement in patient care and client relations across the enterprise. ▪ Prepared reports, presentations, and training materials. Trained groups of 100+ adult learners on healthcare-related systems and applications. Praised in reviews for my ability to quickly master and impart complex material (P&Ps/Apps/Software/Processes) in a graspable and retainable language for trainees/team members. ▪ Successfully managed team and independent projects focused on service improvement. ▪ Trained teams on Pharmacy concepts, regulations, PBM processes, provider-specific materials, contract adherence, and UM. ▪ Independently developed and executed SFO team training and improvement strategies. Increased team’s level of service excellence to standards compliant with ACHC requirements and contractual performance goals. Key performance indicators were exceeded and QA stats increased by 30% (2009-2010). ▪ Earned a reputation as a valuable and cooperative coworker by being fair, honest, and quick to proactively help others. ▪ Highly regarded by team for swift problem resolution & developing forward-thinking strategies aimed at long-term success. Attended monthly corporate planning meetings and weekly leadership meetings for management to collaborate in writing, updating, reviewing policies & procedures, provider contracts, performance goals, strategies, current events, business needs, organizational chart changes, and other topics of relevance. ▪ Responsibilities included training & developing teams - entry-level & veteran: PCAs, Clinical RNs, RPhs, B&R reps, CPTs, Account Managers, Social Workers, UM and hub teams dedicated to specialized disease states and limited-distribution drugs (e.g.: Acthar, Synagis, Iressa, PAH, IVIG, Hemophilia, HGH). Tracked progress and completed weekly reviews/reports impacting bonus potential, merit increase, hiring decisions & advancement of trainees. Show less



CuraScript, Inc. An Express Scripts Co.

• Pharmaceutical Manufacturing
• 200 - 300 Employee

• Finance - Sr. Client Auditor

  • 2007 - 2008

  ▪ Performed gap analysis and business assessment to identify financial variances related to B&R and contractual adherence. Coordinated resources and developed project plans to correct discrepancies, support or dispute internal and external audits, and promote revenue growth and loss prevention; subsequently managed said projects ▪ Maintained client satisfaction by anticipating client needs and providing attentive service & prompt issue resolution. ▪ Successfully increased annual revenue… Show more ▪ Performed gap analysis and business assessment to identify financial variances related to B&R and contractual adherence. Coordinated resources and developed project plans to correct discrepancies, support or dispute internal and external audits, and promote revenue growth and loss prevention; subsequently managed said projects ▪ Maintained client satisfaction by anticipating client needs and providing attentive service & prompt issue resolution. ▪ Successfully increased annual revenue to the corporation by over 2 million dollars in less than 1 year independently (2007-2008). Collaborated to successfully increase revenue by an additional 5.8 million dollars through audit findings, defensive action, and client mediation efforts in less than 1 year (2007-2008). ▪ Brokered win-win agreements among multiple lines of business, including corporate representatives of VIP clients, such as Tricare/DOD, CIGNA, BCBS, Aetna, Healthnet, Medicare, and Medicaid. ▪ Drove strong and sustained profit improvements by controlling costs and steering stable departmental operations with high client retention rates. Created one of the best on-time performance records in the audit department (2007-2008). ▪ Reviewed claims for completeness, accuracy, and correct coding. Processed/adjudicated claims per plan policies and applicable contract(s). Show less ▪ Performed gap analysis and business assessment to identify financial variances related to B&R and contractual adherence. Coordinated resources and developed project plans to correct discrepancies, support or dispute internal and external audits, and promote revenue growth and loss prevention; subsequently managed said projects ▪ Maintained client satisfaction by anticipating client needs and providing attentive service & prompt issue resolution. ▪ Successfully increased annual revenue… Show more ▪ Performed gap analysis and business assessment to identify financial variances related to B&R and contractual adherence. Coordinated resources and developed project plans to correct discrepancies, support or dispute internal and external audits, and promote revenue growth and loss prevention; subsequently managed said projects ▪ Maintained client satisfaction by anticipating client needs and providing attentive service & prompt issue resolution. ▪ Successfully increased annual revenue to the corporation by over 2 million dollars in less than 1 year independently (2007-2008). Collaborated to successfully increase revenue by an additional 5.8 million dollars through audit findings, defensive action, and client mediation efforts in less than 1 year (2007-2008). ▪ Brokered win-win agreements among multiple lines of business, including corporate representatives of VIP clients, such as Tricare/DOD, CIGNA, BCBS, Aetna, Healthnet, Medicare, and Medicaid. ▪ Drove strong and sustained profit improvements by controlling costs and steering stable departmental operations with high client retention rates. Created one of the best on-time performance records in the audit department (2007-2008). ▪ Reviewed claims for completeness, accuracy, and correct coding. Processed/adjudicated claims per plan policies and applicable contract(s). Show less



Florida Hospital

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

• Account Manager

  • 2006 - 2007

  ▪ Analyzed problems and anticipated client needs. Maintained and encouraged client satisfaction through the courteous and resourceful resolution of disputes, complaints, and discrepancies. ▪ Communicated with FH Clients, including Medicaid and Medicare, to validate contractual obligations were met in a timely manner, ensure accurate reimbursement, and provide support whenever necessary. ▪ Liaised between Florida Hospital patients/clients and providers to facilitate account negotiations… Show more ▪ Analyzed problems and anticipated client needs. Maintained and encouraged client satisfaction through the courteous and resourceful resolution of disputes, complaints, and discrepancies. ▪ Communicated with FH Clients, including Medicaid and Medicare, to validate contractual obligations were met in a timely manner, ensure accurate reimbursement, and provide support whenever necessary. ▪ Liaised between Florida Hospital patients/clients and providers to facilitate account negotiations and claim settlements. ▪ Reviewed claims for completeness, accuracy, and correct coding. Processed/adjudicated medical, workman's comp, and accident/injury/liability claims according to health plan policies and applicable contract specifics. ▪ Independently managed projects aimed at (contract/B&R) variance reduction. ▪ Performed audits to compare online provider contracts/manuals to departmental internal platforms and ensure consistency, accuracy, and alignment. Show less ▪ Analyzed problems and anticipated client needs. Maintained and encouraged client satisfaction through the courteous and resourceful resolution of disputes, complaints, and discrepancies. ▪ Communicated with FH Clients, including Medicaid and Medicare, to validate contractual obligations were met in a timely manner, ensure accurate reimbursement, and provide support whenever necessary. ▪ Liaised between Florida Hospital patients/clients and providers to facilitate account negotiations… Show more ▪ Analyzed problems and anticipated client needs. Maintained and encouraged client satisfaction through the courteous and resourceful resolution of disputes, complaints, and discrepancies. ▪ Communicated with FH Clients, including Medicaid and Medicare, to validate contractual obligations were met in a timely manner, ensure accurate reimbursement, and provide support whenever necessary. ▪ Liaised between Florida Hospital patients/clients and providers to facilitate account negotiations and claim settlements. ▪ Reviewed claims for completeness, accuracy, and correct coding. Processed/adjudicated medical, workman's comp, and accident/injury/liability claims according to health plan policies and applicable contract specifics. ▪ Independently managed projects aimed at (contract/B&R) variance reduction. ▪ Performed audits to compare online provider contracts/manuals to departmental internal platforms and ensure consistency, accuracy, and alignment. Show less



LTC Pharmacy

• United States
• Personal Care Product Manufacturing

• Pharmacy Technician

  • 2005 - 2007

  ▪ Provided superior customer service and work quality while demonstrating attention to detail, flexibility and innovation in resolving problems. Trained and developed new hires. ▪ Researched requests, checked availability, and, if necessary, recommended alternative products to complete orders. ▪ Consolidated orders to minimize shipping costs, managed client database, and worked in conjunction with technical, accounting, and sales departments. Prepared intravenous (IV) packs… Show more ▪ Provided superior customer service and work quality while demonstrating attention to detail, flexibility and innovation in resolving problems. Trained and developed new hires. ▪ Researched requests, checked availability, and, if necessary, recommended alternative products to complete orders. ▪ Consolidated orders to minimize shipping costs, managed client database, and worked in conjunction with technical, accounting, and sales departments. Prepared intravenous (IV) packs, pumps/supplies, etc., using sterile technique. ▪ Compounded medications, using standard formulas and processes, such as weighing, measuring, and mixing ingredients. ▪ Maintained records, such as pharmacy files, charge system, inventory, and control records. ▪ Maintained knowledge & adherence of current Healthcare laws/state regulatory guidelines/established procedures concerning QA, confidentiality, security of controlled substances, and disposal of hazardous waste. Show less ▪ Provided superior customer service and work quality while demonstrating attention to detail, flexibility and innovation in resolving problems. Trained and developed new hires. ▪ Researched requests, checked availability, and, if necessary, recommended alternative products to complete orders. ▪ Consolidated orders to minimize shipping costs, managed client database, and worked in conjunction with technical, accounting, and sales departments. Prepared intravenous (IV) packs… Show more ▪ Provided superior customer service and work quality while demonstrating attention to detail, flexibility and innovation in resolving problems. Trained and developed new hires. ▪ Researched requests, checked availability, and, if necessary, recommended alternative products to complete orders. ▪ Consolidated orders to minimize shipping costs, managed client database, and worked in conjunction with technical, accounting, and sales departments. Prepared intravenous (IV) packs, pumps/supplies, etc., using sterile technique. ▪ Compounded medications, using standard formulas and processes, such as weighing, measuring, and mixing ingredients. ▪ Maintained records, such as pharmacy files, charge system, inventory, and control records. ▪ Maintained knowledge & adherence of current Healthcare laws/state regulatory guidelines/established procedures concerning QA, confidentiality, security of controlled substances, and disposal of hazardous waste. Show less



Eckerd/CVS Pharmacy

• Pharmacy Technician Supervisor

  • 1997 - 2005

  ▪ Allocated resources; procured & managed inventory; Performed quarterly audits on Class II narcotics to ensure accuracy of dispensing records & inventory. Maintained records, such as pharmacy files, charge system, non-narcotic drug inventory, and control records. Maintained patient/client confidentiality per HIPAA standards. ▪ Completed insurance verification & processed claims for billing & reimbursement. ▪ Compounded medications using standard formulas and processes. ▪ Maintained… Show more ▪ Allocated resources; procured & managed inventory; Performed quarterly audits on Class II narcotics to ensure accuracy of dispensing records & inventory. Maintained records, such as pharmacy files, charge system, non-narcotic drug inventory, and control records. Maintained patient/client confidentiality per HIPAA standards. ▪ Completed insurance verification & processed claims for billing & reimbursement. ▪ Compounded medications using standard formulas and processes. ▪ Maintained established procedures concerning QA, security of controlled substances, and disposal of hazardous waste. ▪ Planned and implemented procedures in pharmacy, such as mixing, packaging, and labeling pharmaceuticals according to policies and legal requirements. Maintained department's knowledge & adherence of current Healthcare laws & state regulatory guidelines. Scheduled, trained, and managed teams. Provided management support for 6 different locations. Show less ▪ Allocated resources; procured & managed inventory; Performed quarterly audits on Class II narcotics to ensure accuracy of dispensing records & inventory. Maintained records, such as pharmacy files, charge system, non-narcotic drug inventory, and control records. Maintained patient/client confidentiality per HIPAA standards. ▪ Completed insurance verification & processed claims for billing & reimbursement. ▪ Compounded medications using standard formulas and processes. ▪ Maintained… Show more ▪ Allocated resources; procured & managed inventory; Performed quarterly audits on Class II narcotics to ensure accuracy of dispensing records & inventory. Maintained records, such as pharmacy files, charge system, non-narcotic drug inventory, and control records. Maintained patient/client confidentiality per HIPAA standards. ▪ Completed insurance verification & processed claims for billing & reimbursement. ▪ Compounded medications using standard formulas and processes. ▪ Maintained established procedures concerning QA, security of controlled substances, and disposal of hazardous waste. ▪ Planned and implemented procedures in pharmacy, such as mixing, packaging, and labeling pharmaceuticals according to policies and legal requirements. Maintained department's knowledge & adherence of current Healthcare laws & state regulatory guidelines. Scheduled, trained, and managed teams. Provided management support for 6 different locations. Show less