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coordinator payor operations account solutions resume example with 10+ years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Summary

· Proactively takes on a problem-solving role in pressing issues, operating with a sense of urgency while maintaining attention to detail to ensure issues are resolved in a swift and accurate manner.

· Adapts quickly to the ever-changing healthcare industry with ease and seeks opportunities to develop new processes and create efficiencies.

Work Experience
07/2016 to Current Coordinator, Payor Operations & Account Solutions New Directions Behavioral Health | Concord, CA,
  • Assist with contract management which resulted in $9.1 trillion dollars in governance revenue for my clients in 2022
  • Special teams project lead for the distribution of COVID-19 vaccine opportunities for fortune 500 companies to the sales team, contributing in over 1,700 opportunities and 5.5 million vaccines in the United States
  • Act as trusted liaison for 23 Pharmacy Benefit Managers, conveying their feedback to appropriate internal teams to ensure our successful partnership
  • Utilize Salesforce and Tableau to analyze Maximum Allowable Charge (MAC) data for brand, generic and specialty drugs and report any significant differences to assist in negotiating future contracts
  • Implement improvements to internal processes and create efficiencies leveraging my strong knowledge of healthcare
  • Organize internal/external stakeholder meetings to optimize timely deliverables
  • Collaborates with contracting, sales, licensing, legal, specialty and compliance to complete required attestation, credentialing, Fraud Waste & Abuse, chain verification and compliance documents against quick turnaround deadlines.
  • Manages all data entry into Salesforce for Managed Care plans. Working with sales in exchanging new opportunities and analyzing how to increase customer value, customer satisfaction and retention.
  • Conduct weekly client calls for implementation of pharmacy benefit plans and assist contracting, operations, and sales teams to guarantee successful plan activation for in-store and mail-order patients
  • Review client documents for drug price changes, reporting any significant changes to leadership for future contract negotiations
  • Proactively takes on a problem-solving role in pressing issues, operating with a sense of urgency while maintaining attention to detail to ensure issues are resolved in a swift and accurate manner.
  • Meticulously interpret Provider Service Agreements to ensure contracts are clearly communicated, observed, and transferred into spreadsheets to inform compliance, reconciliation, and pricing and underwriting decisions
  • Adapts quickly to the ever-changing healthcare industry with ease and seeks opportunities to develop new processes and create efficiencies.
07/2016 to 11/2019 Contracting Coordinator Walgreen Co. | City, STATE,
  • Liaison between Walgreens retail store and Pharmacy Benefit Manager, tasked with investigating time-sensitive patient issues
  • Implemented pharmacy industry changes by gathering pertinent plan information and communicating plan changes to pharmacy operations for Managed Care & Direct Bill plans.
  • Tracked and handled contracts through entire routing process for both Managed Care & Direct Bill
  • Prepared client-contract executive summaries and respond to legal concerns
  • Identified and implemented improvements to internal processes for Managed Care & Direct Bill
  • Monitored client profitability through ongoing analysis of financials
01/2013 to 07/2016 Employee Services Representative Illinois Tollway | City, STATE,
  • Responsible for overseeing all details of the prescribed hiring life cycle which includes: updating job descriptions, ensuring job notices and postings are sent to internal and external sources, overseeing details surrounding pre-employment testing, conducting interviews and totaling the combined interviewers’ scoring sheets
  • Assisted in testing and implementing designated recruiting platform (NEOGOV) and necessary enhancements for Employee Services functions and personally launched the Illinois Tollways LinkedIn page
  • Created new strategic recruiting methods and best practices, assisted in conducting internal reviews of processes and procedures within the HR Department, and completed special recruiting projects to continuously improve the hiring process
  • Prepared bi-weekly candidate status reports and delivered monthly to the Chief of Administration and Chief of Staff while reporting directly to Executive Director of Employee Services
  • Developed and delivered high quality standard recruiting presentations to prospective candidates during career expos and job fairs, articulating key benefits of a position at the Illinois Tollway and ensuring potential candidates are informed on how to apply through the external recruiting platform
Education and Training
Expected in 12/2013 to to Associate of Arts | Liberal Arts And General Studies William Rainey Harper College, Palatine, IL GPA:

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Resume Overview

School Attended

  • William Rainey Harper College

Job Titles Held:

  • Coordinator, Payor Operations & Account Solutions
  • Contracting Coordinator
  • Employee Services Representative

Degrees

  • Associate of Arts

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