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Pharmacy Systems Specialist TPA Resume Example

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PHARMACY SYSTEMS SPECIALIST TPA
Work History
Pharmacy Systems Specialist TPA, 01/2016 to 01/2020Banner Health - Banner Pharmacy Services - Phoenix, AZ
  • Investigate and ensure accuracy of pharmacy third party reconciliation processes. Review, maintain, and adjust patient AR accounts to ensure accuracy. Provide support for pharmacy team members with complex billing issues. Monitor and reconcile third party payments. Communicate internally and externally with appropriate parties to resolve billing issues
  • Research and identify solutions to billing inquiries related to patient AR accounts and coordinate monthly interdepartmental billing with accounting office
  • Execute on contracting, auditing, and credentialing requirements for third party payers including commercial, Medicare and Medicaid. Facilitate legal requests to initiate and maintain pharmacy third party contracts
  • Complete all necessary credentialing and re-credentialing for all pharmacy locations as required by individual third-party payers
  • Investigate and respond to audit requests for third party desktop and on-site audits for all outpatient and specialty pharmacy areas. Coordinate with all appropriate teams and lead processes for all onsite audits. Report results of third-party audits appropriately
  • Ensure competency with third party billing requirements, monitor and communicate upcoming changes, and work collaboratively with pharmacy leadership to implement necessary changes
  • Train pharmacy team members when third party billing problems are identified and assist in implementation of solutions to prevent future occurrences. Review and analyze current patterns, processes and strategies to develop or improve methods that will meet changing organization requirements
  • Development and management of new employee training program for retail, specialty, and home delivery business lines
  • Pricing specialist responsible for development of discount pricing programs and pricing related policies and procedures. Resource for all interdepartmental and staff pricing inquiries
Certified Pharmacy Technician II, 10/2014 to 01/2016Banner Health - Banner Family Pharmacy Chandler - Chandler, AZ
  • Patient liaison between care providers such as physicians, pharmacies, insurance providers, and facilities to ensure fulfillment of pharmaceutical needs and improve medication adherence
  • Development of new employee training processes
  • Key resource in development of policies and procedures of quickly expanding Pharmacy Support Services department
  • Development and maintenance of compliance and workflow aids for pharmacists and technicians
  • Member of team assigned to develop Operation Scorecard designed to measure operational, financial, clinical, safety, and service metrics
  • Worked in conjunction with clinical and financial performance analysts to present data to variety of audiences
  • Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments
Cytology Prep Technician, 05/2013 to 10/2014Banner Health - Sonora Quest Laboratories - Tempe, AZ
  • Collect relevant clinical data from other Banner facilities for pathologist analysis and diagnosis
  • Processes cytology samples for high complexity analysis in accurate and timely manner
  • Responsible for ensuring department compliance with laboratory accreditation agencies and regulatory requirements (e.g., CLIA '88, JCAHO, CAP, OSHA) related to Non-Gynecological specimen preparation
Certified Pharmacy Technician II , 02/2005 to 05/2013Banner Health - Banner Gateway Medical Center - Gilbert, AZ
  • Standardized processes and control of high-use and emergency medications to assist integration of new software implemented to improve patient safety
  • Developed and communicated set of standardized guidelines for distribution of specific classes of medications to various departments
  • Oversaw inventory control, ordered medications while focusing on cost control, utilization, ease of use, emergency protocols
  • Analyzed medication usage, adjusted inventory to maximize space and ease of distribution
  • Evaluated medication needs by department, ensured that patient safety guidelines were followed
Skills
  • Project Management
  • Problem Solving
  • Data Analysis
  • Policy Development
  • Strategic Planning
  • Customer Service
  • Claim Resolution
  • Collaboration
  • Training and Development
Education
Master of Science, Health Care Delivery, Expected in 05/2020
Arizona State University - Tempe, AZ

Capstone: Banner Family Pharmacy Pricing Project -Improving Patient Prescription Affordability and Adherence

Lean Six Sigma Certification (pending)

Bachelor of Science, Biology, 01/2011
Arizona State University - Tempe, AZ
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Resume Overview

Companies Worked For:

  • Banner Health - Banner Pharmacy Services
  • Banner Health - Banner Family Pharmacy Chandler
  • Banner Health - Sonora Quest Laboratories
  • Banner Health - Banner Gateway Medical Center

School Attended

  • Arizona State University

Job Titles Held:

  • Pharmacy Systems Specialist TPA
  • Certified Pharmacy Technician II
  • Cytology Prep Technician

Degrees

  • Master of Science , Health Care Delivery Expected in 05/2020
    Bachelor of Science , Biology 01/2011

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