To obtain Pharmacy Benefit Manager position and to contribute to the success of the company.
PTCB certified since March 23, 2009.
Certification number 470101090262717
Set up pharmacy benefits for new clients and maintaining plans for existing and new clients. Maintain product lists for PBM Plus. Supervisor of call center for pharmacy benefits. Train all new employees on both mail order system and call center system. In charge of data entry for our mail service pharmacy. Assist call center with all rejected claims, pharmacy contracting. On call to assist pharmacies, members and clients after hours. Maintain MAC reviews for pharmacy pricing, also includes reviewing claims for pharmacies' due to loss in reimbursement. Process customer reimbursements. Handle payroll approval and scheduling for my employees. Engaged other functional areas in researching complex or escalated issues. Analyzed the success and effectiveness of benefit requests and projects. Communicated at a broad level.Conducted industry and client research and analysis to identify opportunities for improvement.Executed the testing and implementation of new business processes.
•Set up pharmacy benefits and maintaining the plans for existing and new clients. Run trial claims for plans in the process of completion. Maintain product lists for PBM Plus.
Assist call center with rejected claims, pharmacy contracting. On call to assist pharmacies, members, and clients after hours. Maintain MAC reviews for pharmacy pricing. Review claims for pharmacies' due to loss in reimbursement.Assist with calls for missing documents, and EFT payment set up. Research claims that have been submitted by pharmacies to ensure they are submitted in a timely fashion. Contracting, and ancillary services.
Assisted with contracting of national pharmacies, assist with prescription entry, assist members with copayment questions and benefits. Train all new employees on the systems for our mail service pharmacy and call center. Receive incoming calls from all hunt groups, resolved issues for members, pharmacies and clients.
Soccer coach 2009-2011 - Clermont Northeastern Elementary School
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