pharmacy systems specialist tpa resume example with 14+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
:
Work History
Pharmacy Systems Specialist TPA, 01/2016 - 01/2020 Boston Medical Center – Boston, MA,
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 - 01/2016 Sonora Quest Laboratories – 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 - 10/2014 Boston Medical Center – Boston, MA,
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 - 05/2013 Banner Health - Banner Gateway Medical Center – City, STATE,
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 GPA: Status -
Capstone: Banner Family Pharmacy Pricing Project -Improving Patient Prescription Affordability and Adherence
Lean Six Sigma Certification (pending)
Bachelor of Science: Biology, Expected in 01/2011 - Arizona State University - Tempe, AZ GPA: Status -
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