Reliable Associate Governmental Program Analyst offering an extensive 24-year background working as a health care professional in Elk Grove. Recognized for accomplishing 100% of goals and objectives. Polished professional known for interactions with the public that are fair, compassionate and respectful. Promoting detailed research, planning and development of health care programs.
Employed with Covered California as an AGPA Appeals Analyst in the Consumer Relations and Resolutions department. My primary responsibility was to assist Covered California consumers resolve their appeal informally without a hearing.
•Responsible for reviewing and responding to appeals reported byconsumers doing business with Covered California.
•Independently analyze, research, and resolve issues using a variety oftools and policies available to ensure swift and accurate resolution.
Refer to the California Code of Regulations Title 10, Chapter 12, Article 5 to informally resolve appeal.
• Responsible for drafting and presenting a Statement of Position at the hearing on behalf of Covered CA siting the pertinent regulations to support any exhibits provided by CalHEERS and the qualified health plan.
• Assigned additional tasks to assist my manager due my below average caseload.
• Drafted a task guide for the department outlining how to upload Notices of Dismissal into CRM.
Employed as a pharmacy technician in the Pharmacy Services Center for Centene. Centene manages government sponsored healthcare programs and provides services to millions of members nationwide.
• Provided members, medical professionals, and pharmacies information and tools to help navigate the Medi-Care and Medicaid programs according to the laws, procedures and guidelines set forth by the State and Federal government.
• Independently researched and made decisions in accordance of rules of the healthcare program in which members are enrolled.
• Proficient in MediCaid and MediCare government healthcare program pharmacy coverage including contracts and addendums.
• Access to PHI and HIPAA protected information including patient pharmacy transactions, ICL/TrOOP and deductible information. Access to insurance plan formularies; calculate copays, and OOP costs
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