Navigating patient assistance programs, communicating with dispensing pharmacies, creating tasks for the medical team. Completing and following up on prior authorizations via electronic prior authorizationportals, phone, and facsimile. Triage pharmacy calls and voicemails to the appropriatedepartment. Leverage strong computer skills and the ability to navigate through multiplesystems to research information quickly. Ensure quality member experiences are consistentlydelivered following all local, state, and federal guidelines. Provide accurate, valid, andcomplete information by using the right methods/tools

Negotiated with pharmaceutical representatives to lower drug acquisition costs by 18% while maintaining a 95% stock availability. Managed a $5M budget, consistently coming in under budget by at least 5% each fiscal year through meticulous cost-control measures.Deployed a new customer relationship management (CRM) platform that increased patient engagement and loyalty, with a 35% improvement in repeat customer transactions.Led the onboarding and training of 10 pharmacy operation specialists ,equipped them with the necessary skills to excel in patient care and pharmacy operations.

Developed, monitored, coached, and managed a team of 15 insurance verification specialists, ensured the development of employees through orientation, training established objectives, communication of rules, and constructive discipline.Worked cross functionally to manage the entire process from insurance verification to final collection. Liaisoned with internal departments to promote ongoing communication and ensure accuracy.Monitored and validated adherence to policies and procedures, audited as necessary.

Verified patient eligibility, coordinated benefits, ran test claims, and determined patient coverage/responsibility for services including, but not limited to, major medical insurance benefits (including Medicare), complex insurance plans, and high volume PBM plans. Communicated with healthcare providers via fax, phone, and email. Translated patient information into ICD-10/ICD-9/CPT codes, entered medical records into the EHR database, and ensured compliance with HIPAA regulations and data protection laws for confidential information.