Afroze Qureshi Email & Phone Number

Falls Church

• Build quarterly pricing files through synthesis of data across multiple databases, analysis, and application of refund pricing and agreement information to bill pharmaceutical manufacturers. • Analyze pharmacy utilization claims to assist in beneficial decision making such as establishing trends, identifying billing errors to be resolved, as well as strategic planning. • Derive formulas through application of data models to use in calculating refunds based on terms of individual drug agreements when billing drugs under Additional Discount Programs. • Compile and manage information to ensure accurate refund billing and processing, such as product eligibility for TRICARE Retail Refund Program and NDC assignment under the 3 standard and additional discount programs. • Serve as primary liaison between Defense Health Agency and over 300 pharmaceutical manufacturers primarily to obtain pricing agreements, ensure compliance of agreements for discount programs, and provide Program information and support. • Provide consultation services and recommendations to internal and external clients. • Assist in managing formularies through maintenance of Tier 3 non-formulary Section 703 master list and providing updates at each quarterly Pharmacy & Therapeutics Committee Meeting.• Develop reports and processes to optimize operation of Program. • Writing requirements, Standard Operating Procedures, and other technical documents.

Falls Church, Va

• Reviewed completed/submitted claims to ensure proper billing and reimbursement from third party payers. • Compiled and interpreted cost benefits/ utilization analysis reports.• Provided specialized assistance to Medicare/Medicaid program customers and providers as well as government agencies by responding to inquiries, researching, reviewing and analyzing health care information, legislation/regulation; identifying and reporting cases of potential Medicaid program fraud and abuse. • Managed patient accounts including completing patient health assessments, researching and verifying patient insurance benefits, organizing and securing confidential patient health information, and payment posting. • Liaised with physician offices to initiate therapeutic interchanges, prior authorizations, and report adverse events. • Reviewed patient medical information; ensured receipt of correct prescription scripts prior to electronic submission, database processing and storage.

Fairfax Station, Va

• Managed pharmacy inventory: cycle counts, ordered medications, ensured that the correct amount of each medicine was in stock and within budget. • Retrieved prescription scripts, verified and electronically submitted them into database. • Filed and processed insurance claims.• Verified patient insurance coverage, prior authorization approvals/denials, reversed claims, adjustments and reimbursements, and ensured proper paid claims were captured. • Provided resourceful customer service, consultations, ensured drug compliance, and completed sales transactions.

Master Of Business Administration (Mba)

Bachelor'S Degree, Health Systems Management