Career Objective: To locate a position with an organization that offers opportunity for advancement and personal growth.
Skills: Proficient in Windows XP Microsoft Word, Excel, Access, Outlook, Med Response, Med Access, Med Optimize, and HBS.
Additional Information: National Certified Pharmacy Technician since 1985 – present. On a consulting basis analyzing and researching medical claims for insurance companies to ensure accuracy in billing guidelines and reimbursement. Claims existing for hospital, medical offices, third party administrators and private pay claims.
Experience:
October 2010-Present. Pharmacy Services and Audit Coordinator, Sav-Mor Franchises. Novi, Michigan. Work with PBM's and pharmacies to resolve claim processing issues. Review on-site and desk audits prior to submission to auditors. Analyze HBS Chain Host reports using a variety of reporting tools, submitting MAC underpayments to insurance companies, preparing appeals for on-site and desk audit findings, FWA compliance training and credentialing for pharmacies and physicians.
March 2005-October 2010. Pharmacy Analyst, Henry Ford Health Systems. Detroit, Michigan. Assist with claim processing and researching requests for prior authorizations for claim adjudication. Troubleshooting and resolving drug claim issues for members, physicians, and pharmacies. Assist in the implementation of pharmacy benefit designs while acting as a resource for pharmacy benefit questions. Instrumental in implementing the Medicare Part D pharmacy program and processing Medicare Part D transitions. Performing NCQA quarterly audits and maintaining assigned reports, logs, databases, MAC pricing, on-site and desk audits.
Sept 2004- March 2005. Account Receivable Analyst. Providence- St. Johns Health System, Southfield, Michigan. Outpatient and Inpatient hospital billing existing of initial claims, reviewing claims, posting and working rejections, obtaining prior authorizations for Medicaid and all Medicaid HMO’s. Resolving patient concerns regarding billing issues.
Aug 1999- April 2003. Product Analyst, IPG Services, Troy, Michigan. On assignment at General Motors Responsibilities included supporting Product Assurance Team. Analyzing dealer complaints through the Problem Tracking System (PTS) generating a daily, monthly, and year-end report. Distribution of a Problem Tracking Report (PTR) to management and other colleagues. Investigating problems to find solutions for issues existing from dealers. Assisted in Internal ISO 9001:2000 audits, accounts payable and processing invoices.
July 1996 - Aug 1999. Billing Specialist, Henry Ford Health Systems, Southfield, Michigan. Responsibilities included cash postings,...
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