SUMMARY:

• Ability to leverage communication and interpersonal skills to establish strong relationships with internal & external contacts within various industries.
• Efficient at multi - tasking, time management, and balancing priorities.
• Proven record of providing outstanding customer service.
• Demonstrated ability to remain flexible and exercise solid judgment under pressure.
• Comprehensive knowledge of health plan product portfolio.
• Technologically savvy.
• Self-learner, with proven ability to work both independently and as part of a team requiring minimal direction.
• Capability to work in any industry, in any field due to overall core competency.

PROFESSIONAL EXPERIENCE:

Confidential, Wellesley, MA

Associate Pharmacy Operations Coordinator

Responsibilities:

• Coordinate Processing of prescription requests for by Providers.
• Analyze Fraud, Waste, Abuse data quarterly and provide relevant reports to Pharmacists within Dept.
• Interpret Prompt Pay Reports and Performance Guarantees from primary PBM to continue delivery of adequate member resolution and service and ensure accountability.
• Work with Pharmacy Benefits Manager on resolution for member benefits and claims inquiries.
• Connect with other business areas to stay up to date and assist with member pharmacy inquires.
• Facilitate day to day processing and intake of non-formulary or quantity exception requests.
• Collaborate and communicate with team on pharmacy trends and process improvement opportunities.
• Work with Pharmacy team to manage intake files.
• Maintain weekly drug update files weekly to ensure accuracy.
• Maintain call pager to ensure member resolution during off work hours.
• Attend various Pharmacy team and Company meetings for ongoing process improvement and updates.
• Follow up with Providers regarding specifics requests for Prior Authorizations.
• Maintain C quality control of databases and offer corrections and suggestions as necessary.
• Research phone inquiries by other departments relative to member claims/benefit issues.

Confidential, Wellesley, MA

Vice-Chair

Responsibilities:

• Supports and is back up for Chair with the following duties:
• Lead monthly meetings
• Creating agendas
• Keeping conversations on track
• Delegate event and project tasks
• Keeping track of delegations and event/project completions
• Brainstorm ideas for Committee and membership development
• Work with Executive Sponsors to ensure direction and corporate support
• Work with CII to aid when needed
• Attend tangential ERG/CII meetings
• ERGLT (monthly) - Currently Mona is doing on our behalf, but may revisit co-chair involvement
• ERG Connection (quarterly)
• Inclusion Advisory Council (monthly)
• Occasionally representing O.P.E.N. at HPHC events
• This position will have an end goal of taking over the Chair position.

Confidential, Quincy, MA

Member Service Representative

Responsibilities:

• Research Member inquiries regarding pharmacy claims and benefits.
• Mentor peers to enhance their performance relevant to Pharmacy products/systems in Member Services.
• Analyze claims in ESD systems and resolve problems to ensure first call resolution.
• Transmit pharmacy authorization requests to Providers on behalf of members.
• Research Medical Policy Criteria relevant to medication and medical coverage inquiries.
• Consistently remain updated on pharmacy changes that impact Member Services.
• Perform test claims to ensure member related inquiries are resolved.
• Follow up with Members to advise Pharmacy inquiries are resolved.
• Reach out to Vendor Eligibility for Direct Pay/Non-Direct Pay eligibility issues & updates.
• Contact providers/third parties regarding medical, dental, and pharmacy billing and claims.
• Work both individually and in a team work environment within Member Services.
• Obtain training and ongoing knowledge for situations that impact the MAPS organization.
• Actively sought out by Supervisors to assist with completion of team workload.
• Participated and facilitated in BCBSMA Bright Ideas Panel and focus groups to enhance service.
• Report to Management with regards to trends and any issues related to Member Services.
• Coordinated and assisted with transitioning, welcoming, and setup of new associates to team.
• Job shadowed with a Business Expert within CEP 4 to view their job roles/responsibilities.
• Attend team meetings and take an interactive approach offering suggestions and
• Assist with team minutes for record keeping or those that missed meetings as a point of reference.
• Assume Leadership Role being sought out by peers/Associates to provide letter of recommendation

Confidential, BROCKTON, MA

Pharmacy Technician

Responsibilities:

• Answer calls from patients and providers regarding medication inquiries.
• Preparing medications for verification by pharmacist on prescription orders.
• Assisting with inventory control issues (ordering, returns, checking in daily orders, etc).
• Replenish and troubleshoot automatic medication dispensing terminal for issues or errors.
• Correct and identify insurance/billing issues.
• Prepare for end of day procedures.
• Maintain active certification by the Confidential as well as licensing as by the Board of Pharmacy.