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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Loney StreetPhiladelphia PA Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEI am seeking employment with a company where I can use my talents, and skills to grow and expand the company. I am bilingual and speak write and translate English to Spanish.EMPLOYMENTJuly 2021-Present Moravia Health, Philadelphia PAHome Health AideProvide Basic House keepingProvide hygiene AssistanceProvide Incontinence CareMedication remindersMeal PreparationPerformed laundry careGrocery store and Pharmacy runsMay 2017 - May 2022 RELATED, Dallas TexasLeasing AgentSpecialized in resident retentionPerformed residential verificationFacilitate renewal and recertification process for all residentsMaintained accurate wait and transfer lists; review applicant files to determine eligibility.Utilize your organizational skills and experience to provide the preeminent affordable housing accommodations in the community.Maintain leasing and marketing reports as neededSupported site and office operations as assigned by manage.May 2014 November 2016 PerformRx, Philadelphia, PAPharmacy Benefits Claims AnalystSubject Matter Expert (SME) Claims Processing/ Plan BenefitsIdentify Root cause, and resolution for all claims processing issues for multiple clients/LOBsResponsible for claims service standardsMaintained knowledge of Medicare and Medicaid-related benefit designs,Performed Implementation testing for New and Renewing BusinessProvided consultative oversight for testing, maintenance, and upgrading of claims processing systemDevelopment of action plans for process improvementDevelopment and execution oversight of Business Requirement DocumentsEnsuring projects are completed in a timely manner, escalating if necessaryJune 2011May 2014 Health Partners, Philadelphia, PAPharmacy AnalystWork with vendor to implement benefits and modifications for all lines of business (Medicare, Medicaid, CHIP)Ad Hoc ReportingTrend analysis of pharmacy utilization for formulary complianceSupport department with questions in regards to claims processing and resolutionTesting of benefits prior to implementationFormulary change review and analysisPharmacy Rebate Analyst & Recipient Restriction Coordinator April 2008 June 2011Support applicable requirements with regulations for rebate postingsQuarterly rebate invoicingContract review and analysis (determine plans market share for specific contract performance)Reconciliation of rebate receivables and ensure proper posting to product lineAssisted in strategic planning based on performance analysisData analyticsOversee Recipient Restriction Program (identify and address inappropriate pharmacy utilization)Pharmacy Technician June 2001 April 2008Answer calls within 30 secondsPrior authorization processing to include working with customers and physicians to ensure the proper administration of drug plansComplaint & Grievance Coordinator July 2000 June 2001Intake and tracking of Medicaid & CHIP complaints and grievancesFollow up to include pharmacy, prescriber, and member outreachCoordinated Medical Director reviewWeekly, monthly, and quarterly reporting |
