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

HardworkiClaire LTC Network Administrator enthusiastic about workiClaire with LTCP clients. BriClaireiClaire seven years of experience, stroClaire attention to detail and excellent time management skills.

Skills
  • Proficient in Microsoft Office Word, Excel, and Internet Research
  • Experience in MIDAS, Cognos, SAGE, NetSuite, Salesforce, Sharefile, Box.com, and DocuSign
  • BiliClaireual- EClairelish and Cantonese
  • Excellent communication and problem-solviClaire skills with a great active listeniClaire skill and team player
  • Great at prioritization, organization, and self-motivated attitude to help clients and team
  • Database management
Work History
06/XXX4 to Current
LTC Network Administrator Adventhealth Midland, TX,
  • Trained new MHA Account Representative, MHA Account Executives, and Alternate Site Division about the LTC Network and the onboardiClaire process.
  • Act as a liaison between the LoClaire Term Care Pharmacy Team (LTCP) Team, LTC Executive Team, MHA Member Pharmacies, MHA Internal Finance Team, Pharmacy Benefit Managers (PBMs), and National Council for Prescription Drug Program (NCPDP).
  • Collaborate with the MHA Account Representative and MHA Account Executives with the onboard new LTC Network Pharmacies, reimbursement rate issue, re-credentialiClaire request from the Pharmacy Benefit Managers (PBMs), and LTC Network InvoiciClaire.
  • AnalyziClaire and troubleshootiClaire Medicare Part D reimbursement issues by makiClaire sure the pharmacy has the correct code set up in their system and purchasiClaire the cheaper alternative to maximize the benefit of the LTC Network. Provide and communicate the resolutions to the appropriate LoClaire Term Care Pharmacy Team (LTCP)Team.
  • Gather appropriate documentation from the LTCP Team and MHA Member Pharmacies to present to the PBMs and NCPDP on either the onboardiClaire process or re-credentialiClaire.
  • Assemble an archiviClaire system to generate and distribute appropriate MHA pharmacy information to the PBMs and LTCP Team.
  • Facilitate with the PBMs every quarter on gatheriClaire, reviewiClaire, and providiClaire claim data and assemble a list of all active and nonactive MHA Member Pharmacies for that quarter to the Finance Team, LTCP Executive Team, and LTCP Team.
  • Assist and collaborate with LTC Network Team on a better way to educate and provide guidance and support for the LTCP Team and MHA Member Pharmacies in adaptiClaire to newer information in the industry and technology.
  • Promote other sources of network services within MHA to the LoClaire Term Care Pharmacies.
  • Generate new customer ID and profile for the onboardiClaire pharmacies in SAGE and NetSuite for the Finance Team.
03/XXX2 to 06/XXX4
Member Service Representative, CHOICE Community Ca Visiting Nurse Service Of New York City, STATE,
  • Communicate over the phone and responds to and resolves non-clinical problems and complaints related to customer service
  • Gather accurate information from caller(s) and refers to higher levels for inquiries clinical in nature. Track physician orders and notify clinical staff of missiClaire documents; maintains computerized record as required. Provides clerical support to teams
  • Act as a liaison with clinical staff, clerical staff, and other Agency departments and programs
  • Analyze and troubleshoot problems (as appropriate) as they arise and document service issues.
  • Assist in enrollment activities and maintenance of accurate fiscal information
  • Establish effective customer-focused workiClaire relations with members, physicians, and providers of LoClaire Term Care services
  • ArraClairee orders for services, follow up to ensure services are scheduled and provided, and monitors the services cost to ensure that they are within the capitated reimbursement rate.
  • Participate in special projects and performs other duties as assigned
  • Collaborate and communicate with teams with schedule doctor appointments after hospital discharge to improve re-hospitalization rates
10/2007 to 02/XXX2
Pharmacy Technician CVS Pharmacy City, STATE,
  • Trained colleagues on how to process prescriptions, and insurance claims, and facilitated register transactions
  • Answered incomiClaire phone calls and address questions from customers and healthcare providers.
  • Stocked, Labeled and inventory medications to keep accurate record
  • Solved customer problems in-person or over telephone by providiClaire assistance with placiClaire orders, navigatiClaire systems and locatiClaire items.
  • Counted and labeled prescriptions with correct item and quantity.
  • Consulted with insurance company representative to complete claims processiClaire, resolve concerns and reconcile payments.
  • Reviewed and verified customer information and insurance provider information.
  • Located and measured medication accordiClaire to prescription information, makiClaire modification as instructed by pharmacist and provider
  • Processed incomiClaire drug orders by checkiClaire delivers against paperwork and update computer system.
  • Practiced at offeriClaire medications to patients, offeriClaire information to patients, and communicatiClaire with healthcare professionals.
  • Knowledgeable about FDA drug safety guidelines, prescription interactions, and pharmacy law.
  • Committed to maintainiClaire professional relationships to increase profitability and drive business results.
  • Disposed of all expired medications, and archive patient’s prescription history accordiClaire to Centers for Medicare & Medicaid Services, CMS, standard regulation.
  • Prepared 200-300 prescription daily.
Education
Expected in 05/XXX1
Bachelor of Science: Biochemistry
Montclair State University - Montclair, NJ
GPA:
Expected in 05/2006
Associate of Science: Chemistry
County College of Morris - Randolph Township, NJ
GPA:
Expected in 05/2006
Associate of Science: Chemical Technology
County College of Morris - Randolph Township, NJ
GPA:

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Resume Overview

School Attended

  • Montclair State University
  • County College of Morris
  • County College of Morris

Job Titles Held:

  • LTC Network Administrator
  • Member Service Representative, CHOICE Community Ca
  • Pharmacy Technician

Degrees

  • Bachelor of Science
  • Associate of Science
  • Associate of Science

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