340b Coordinator Resume
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Cheverly, MD
SUMMARY:
- Nationally certified Pharmacy Technician; registered with the state of Texas
- Thorough knowledge of Pharmacy Benefit Managers (PBMs), pharmacy claim analytics, drug classifications, pharmacy purchasing and inventory management, pharmaceutical abbreviations, pharmacy supply chain and third - party audit reconciliation
- Skilled in Windows, Microsoft Word, Excel, Access, PowerPoint, Outlook, Adobe, Salesforce, 340B Architect, Sentinel, Sentrex and various email and internet systems
- Hands on knowledge of Medicare, Medicaid, CMS, Managed care and commercial insurance plans including pharmacy claims submission, protocol, and audit procedures
PROFESSIONAL EXPERIENCE:
Confidential, Cheverly, MD
340B Coordinator
Responsibilities:
- Write, develop and maintain policies and procedures related to all 340B program activities;
- Oversee and manage Sentry software implementation at main hospital and ED child site;
- CDM and data mapping; oversee implementation of 340B software vendor into current hospital system;
- Analyze current trends with in hospital pharmacy purchasing accounts;
- Present strategic solutions to corporate suite and hospital 340B stakeholders;
- Align current hospital pharmacy operations with 340B compliance requirements;
- Train staff on general 340B information and hospital specific 340B policies and procedures;
- Maintain regular communication and software maintenance with 340B software vendor and pharmacy wholesalers
Confidential, Fort Worth, TX
340B Audit Analyst
Responsibilities:
- Assist current clients with preparation for 340B HRSA and/or 340B drug manufacturer audits, which includes data preparation, 340B compliance research, relevant report generation and review of clients’ current 340B policies and procedures;
- Collaborate with internal implementation and installation teams to make sure clients proposed internal 340B settings match the elections on the OPA 340B database;
- Verify existing information on 340B database is correct and up to date for the client;
- Perform preliminary audits for clients to detect and correct any problems before a formal HRSA audit takes place;
- Attend HRSA audit with client in person or via phone to provide explanation of internal claims qualification process and/or retrieve data needed from clients’ 340B Architect account;
- Provide training webinars and conference calls for clients needing assistance interpreting preliminary audit findings and/or to prepare for a formal HRSA and/or manufacturer audit;
- Direct contact to HRSA, OPA, Apexus and various state Medicaid programs for answer to specific 340B questions directed from the client and facilitate presentations and webinars on general HRSA auditing process and specific workflows within the internal audit team
Confidential, Plano, TX
340B Implementation Coordinator/Pharmacy Network Inventory Administrator
Responsibilities:
- Register and manage Contract Pharmacy registrations to Covered Entities through the Office of Pharmacy Affairs;
- Research and respond to operational and procedural questions surrounding the 340B program, relying on regulations, policies and best practice theories to assure program integrity;
- Remain up to date on state, federal and company policies, procedures and regulations related to the 340B drug pricing program;
- Support overall 340B inventory replenishment and serve as a liaison between the Covered Entity, 340B vendor and Contract Pharmacies;
- Document and create policies and procedures related to work flow, process flow, and reporting to assist in design of systematic improvements related to 340b inventory replenishment programs;
- Work with I.T. departments in designing systematic business solutions in the tracking, monitoring, accounting, and reconciliation of 340B pharmacy inventory replenishment;
- Maintain 340B program documentation and transaction records, validate the accuracy of purchase discounts earned from external suppliers and evaluate the accuracy of payments received from contracted pharmacies;
- Reconcile 340B transactions and perform audits to validate data accuracy and ensure 340B program compliance; and analyze audit results from various entities to identify patterns, trends, variances and opportunities to improve program integrity.
Confidential, Frisco, TX
Night Pharmacy Technician
Responsibilities:
- Data entry of prescription information; electronic submission of claims;
- Determination appropriate insurances to bill; customer service;
- Manage pharmacy inventory; ordering; verify accuracy of prescription at point of sale; pour, count and label prescriptions;
- Answer telephone calls; communicate with prescribers and/or agents to obtain refill authorizations; assist in training new employees; and cashier duties
Confidential, Dallas, TX
Third Party Manager/Pricing Analyst
Responsibilities:
- Manage all phases of the third party plan implementation cycle including plan set-up, testing, and compliance;
- Interact with third party agencies and processors.
- Obtain information for plan set-up and maintenance and perform post audit checks on actual script history;
- Create and execute test plans and clearly document all results; ensure that all programs are coded accurately to mitigate third party rejections;
- Provide support and resolution to store inquiries; Analyze data to yield summary reports on third party plan performance.;
- Communicate with TP contracting group to ensure compliance and service;
- Audit reconciliation; On-Site visits for Audit supervision and support;
- Review and resubmit third party claims using Switch data;
- Reviewed eligibility for participation of the 340B program
- Managed and maintained this vendor relationship; PMP uploads;
- Troubleshoot different aspects of rejections due to incorrect billing information or inappropriate software set up;
- Multi-tasks simultaneously and to prioritize accordingly multiple location issues; Collaborate with leadership on report structures and analysis;
- Set up edits, flag settings, add drugs to host files, support inventory procedures; On-Site visits for Training
- Review and revise current pricing codes to ensure correct pricing Communicate competitive price checks to stores to ensure market price updates are applied and accurate;
- Administer competitive cash pricing card program, including training expectations, enrollment;
- Communicate with Executive team expected trends in profitability, and adjust prices to ensure correct margins
- Coordinate and manage IT pharmacy system enhancements and updates;
- Compose, review and revise SOPs, leadership communications, memos and presentations
Confidential, Frisco, TX
Pharmacy Care Coordinator
Responsibilities:
- Acted as the patient’s advocate to ensure that the prescribed drug therapy and pharmacy care plan are followed as prescribed;
- Assists patients by coordinating their prescribed pharmacy care with the patient’s health care providers, payers, and other health related resources to ensure successful drug therapy outcomes;
- Answers and resolves patient inquiries within committed time frames; reports all adverse events related to drug therapy and pharmacy care;
- Establishes and maintains strong customer relationships with physician practices to streamline communication to the patient, payers, pharmacist, nurse, lab and other healthcare related parties;
- Troubleshoots and resolves patient and payer issues in a timely fashion;
- Maintains current documentation related to patient's drug therapy and pharmacy care plan;
- Coordinates responses and resolutions with appropriate internal and external parties; actively participates in discussions with pharmacists, nursing services, pharmacy support manager and other pharmacy care coordinators to review cases and related drug therapy and pharmacy care plan issues
Confidential, Lakewood, CO
Insurance Eligibility Verification Specialist
Responsibilities:
- Ensures insurance verification, and adjudication rejections are processed accurately, efficiently and in complete accordance with all applicable laws, regulations and company policies;
- Contact insurance companies as required to obtain and enter accurate benefit information and all electronic pharmacy claims processing information;
- Effectively research and resolve prescription adjudication rejections, ensuring patients receive their medications within established patient standards;
- Maintain accurate and current information as required in DaVita Rx spreadsheets for tracking and quality assurance purposes;
- Create and maintain accurate and up to date spreadsheets and information charts for company wide use on state specific Medicaid and Medicare Part D programs; and assist with special projects as needed
Confidential, Greenwood Village, CO
Pharmacy Research Assistant
Responsibilities:
- Assist pharmacists with research of current drug availability;
- Correspond with drug manufacturers and FDA to obtain most recent drug information;
- Data input of patient specific dosing information into database;
- Communicate with managers and other staff to ensure research is up date, accurate and organized; prepare and distribute meeting minutes and analyze incoming memos, submissions, and reports in order to determine their significance and plan their distribution
Confidential, Denver, CO
Pharmacy Intake Specialist
Responsibilities:
- Worked directly with the director of pharmacy in implementing and administering pharmacy benefits for members including the Medicare Part D plan;
- Managed and maintained vendor relationships;
- Review and input J-CODES and ICD -9 codes;
- Managed pharmaceutical representative appointment schedule for pharmacy director; composed reports and correspondence containing decisions of pharmacy director and / or medical director;
- Responsible for assisting in the interviewing process and training new hires;
- Responsible for researching drug authorization requests and inquiries;
- Responsible for follow-up, resolution and feedback to providers and/or pharmacies on the status of prior authorizations,
- Managed drug limitations, policy and procedure; responsible for initial review of all drug authorization requests;
- Provided as needed telephone and administrative support for the department; heavy data entry, including input of HCPCS and ICD-9 codes; insurance verification