Candidate Information Title Specialty Pharmacy Call Center Management Target Location US-FL-Winter Garden Phone Available with paid plan	20,000+ Fresh Resumes Monthly     View Phone Numbers     Receive Resume E-mail Alerts     Post Jobs Free     Link your Free Jobs Page     ... and much more Register on Jobvertise Free
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mkj_1964@yahoo PHONE NUMBER AVAILABLESKILLSRegistered Pharmacy Technician familiar with all aspects of pharmacy/ healthcare operations. Proficient in benefit and program development as well as front and back-end pharmacy operations. Specialized in quality control and training for accredited audit programs. Over 25 years of Call Center, Mail Order, Specialty Pharmacy and PBM management experience. Working knowledge of contract negotiations, quality assurance, workforce management and healthcare financial operations.EXPERIENCEAltamonte Springs, FL Developing and implementation of departmental policies, SOPs, internal process flows and quality improvement initiatives for the 7 specialty pharmacy call centers Oversight of the Pharmacy Customer Associate Manager Is, Team Leads and over 70 PCCs to ensure maximization of the organizations resources as well as hire and train Pharmacy Customer Associates to exceed expected goals and metrics Acts as a SME/liaison for all Pharmacy operations functions for internal and external patients, providers, outside vendors and contracted referral sources Provides tracking and feedback to Senior Leadership on performance KPIs, PGs, SLAs and participates in the performance improvement planning Ensures Pharmacy compliance in accordance with all accreditation programs and regulatory bodies (URAC, CMS, ACHC, NASP and NABP) Experienced with complex therapies for Oncology, Multiple Sclerosis, HIV/AIDS, HCV, Hemo, Transplant, RA/OA along with biologics for other chronic health conditions clinical and financial operations 2020  2021 KabaFusion Huntsville, ALPatient Care Manager Coordinates sourcing and scheduling of 7 Clinical Field Nurses for Infusion, Specialty Therapy and Obstetric home nursing care Reports and tracks timely submission of outsourced Clinical Field Nursing EMR and invoices to corporate Accounts Payable Manages the Clinical and Administrative Intake Staff to ensure Payer reimbursement, benefit determination, coding and authorization adherence2020  2024 BioPlus Specialty PharmacyPatie nt Care Services Manager IIMary K Jackson Assists DON with census reporting as required for licensing and accreditation compliance Maintain standard of care continuum staff training Processes Clinical Field Nursing staff and Administrative payroll Collaborates with sales team to ensure corporate KPIs and patient care goals are met2019  2020 Magellan Pharmacy Orlando, FLHome Delivery Operations Manager Manages day to day Mail Order Pharmacy front and back-end staff of 16 Technicians and Supervisors utilizing ScriptPro, CPR+, IEX and other healthcare platforms Forecasts, analyzes data and prepares pharmacy related reports and presentations for executive team Assists with integrating pharmacy functions within the departments(e.g., Quality, Case Management, Provider Relations) within pharmacology standards Builds and approves SOP, KPIs and training documents Manages clinical staff activities surrounding new implementations and lines of business Maintains State of Florida Pharmacy Technician Registration 2015 - 2019 CVS Health Orlando, FLPharmacy Operations Supervisor Oversee a team of 30 Registered/Certified Pharmacy Technicians to comply with National/State Pharmacology law along with entry production compliant with CVS Quality Standards Workforce and call management adherence using Avaya, CMS, Mattersight, NICE, Genesys Cloud, Mitel and Verint programs Instituted and manage the CVS Health On Boarding Technician Training Program Chairperson of CVS Health CRGClient Services Team Lead Manage a team of 16 Financial Assistance Specialists dedicated to our manufacturer partners to provide Brand support and copay assistance services. Procedural accounting in accordance with Advanced Care Scripts, Inc/Omnicare/CVS and manufacturer DED program guidelines Direct interaction with our CVS partners, pharmacies and patients Reporting trends and outcomes to set department staffing needs and work assignments. Facilitate interdepartmental cross-training and meetings. Develop KPIs and forecast planning reports2007  2015 Aetna Specialty Pharmacy Orlando, FLSenior Quality Consultant Conducted standard quality reviews/audits to measure compliance Supported targeted quality audit projects Reported results and recommendations for training needs, quality controls and process improvement Subject matter expert on workflows, policies, systems requirements/enhancements for daily operations Performed root cause analysis and/or analyze data to identify operational trends Forecasted business activity results and recommended ideas for the development of quality control policies and procedures Managed the Aetna Med D members transition from the MOD platform to the specialty pharmacy business Audited financial assistance compatibility between Med D specialty members and third party payorsPharmacy Operations Trainer Developed and facilitated training sessions to designated audiences; collaborated with supervisors and managers to create curricula specific to the departmental needs Managed all aspects of employee performance and quality auditing to help identify gaps, appropriate training interventions and other variables required to improve business performanceClaims Benefit Specialist Applied medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies and administer all cost containment measures to assist in the claims billing and collections process Triaged and proofed complex claims or referral sources financial reconciliation, coding including diagnostic and procedural, member and provider identification processes Utilized all applicable system functions to ensure accurate and timely claim processing and invoice follow up2000 - 2007 Priority Healthcare/Express Scripts Lake Mary, FL Insurance Coordinator/Reimbursement Specialist Managed complete front-end verification of insurance benefits for specialty biopharmaceutical company Obtained prior authorization/precertification, determined medical necessity based off clinical documentation Reconciled PBM rejections with online adjudication to multiple payors. Reimbursement reconciliation, posted receivables with emphasis on pended or denied claims Managed aggressive collections program on aged accounts receivables EDUCATION1984 -1986 Eastern New Mexico University Clovis, New Mexico 2019 PTU  Pharmacy Training University Orlando, FL REFERENCESAvailable upon request