Alexander Herrera Email & Phone Number

Boston, Massachusetts, United States

Rhode Island, United States

- Broad understanding of health benefits plan setups, (copays, drug coverage, and accumulators).- Researching and assisting with PDE Errors. - Create provider price schedules for new provider contracts when needed- Ongoing testing and auditing, pre and post of client implementation - Works closely with claims system vendor on system enhancements- Updating Lists in the system, or modifying Lists when needed- Work with claims adjudication vendor on errors or issues in the… Show more - Broad understanding of health benefits plan setups, (copays, drug coverage, and accumulators).- Researching and assisting with PDE Errors. - Create provider price schedules for new provider contracts when needed- Ongoing testing and auditing, pre and post of client implementation - Works closely with claims system vendor on system enhancements- Updating Lists in the system, or modifying Lists when needed- Work with claims adjudication vendor on errors or issues in the system, also meet on upcoming changes Show less

Miami/Fort Lauderdale Area

• Ensured agents are in on-going compliance with new/modified processes.• Maintained timely and accurate documentation of client interactions, activities, processes and issue resolution; ensured meeting minutes and action items are prepared and documented • Provided recommendations to drive Service level Agreements• Prepared reports and understand CMS Regulatory Guidance• Prepared monthly and quarterly business reviews• Trained call center agents in health plans… Show more • Ensured agents are in on-going compliance with new/modified processes.• Maintained timely and accurate documentation of client interactions, activities, processes and issue resolution; ensured meeting minutes and action items are prepared and documented • Provided recommendations to drive Service level Agreements• Prepared reports and understand CMS Regulatory Guidance• Prepared monthly and quarterly business reviews• Trained call center agents in health plans, eligibility, Medicare and member services Show less

Puerto Rico

• Interacted with clients to analyze, evaluate and resolve issues.• Developed relations with Clients and ensured client complaints are resolved and not repeated • Studied and evaluated information and present analysis.• Developed, built, and maintained solid client business relationships beginning with a positive on- boarding experience and continuing throughout the life cycle of the client.• Supported RFQs and urgent adjudication and processing issues including doing research… Show more • Interacted with clients to analyze, evaluate and resolve issues.• Developed relations with Clients and ensured client complaints are resolved and not repeated • Studied and evaluated information and present analysis.• Developed, built, and maintained solid client business relationships beginning with a positive on- boarding experience and continuing throughout the life cycle of the client.• Supported RFQs and urgent adjudication and processing issues including doing research, analysis, and identification of root cause, impact analysis determination and corrective action.• Managed the client in compliance with the client service agreement eliminating any risks Show less

Orlando, Florida Area

• Developed comprehensive project plans that merge customer requirements with company goals and coordinate various managers and technical personnel during all project phases, from initial development through implementation.• Built implementation project timeline and managed meetings/deliverables including preparing agendas, documenting meeting notes and tracking issues.• Established a relationship with the employer group and broker contacts• Led employer group meetings to review… Show more • Developed comprehensive project plans that merge customer requirements with company goals and coordinate various managers and technical personnel during all project phases, from initial development through implementation.• Built implementation project timeline and managed meetings/deliverables including preparing agendas, documenting meeting notes and tracking issues.• Established a relationship with the employer group and broker contacts• Led employer group meetings to review functionality issues or participate in roll out discussions• Provided system training to the broker and employer group’s key Administrative Staff Show less

Windermere, Florida

Focused on ensuring the pharmacy benefit meet contractual and regulatory compliance.· Assisted pharmacy director to make sure key timelines, regulatory requirements and production levels are met for each pharmacy benefit or maintenance necessary to fulfill vital functions.· Acted as a point of contact to answer questions regarding benefits, claims, prior authorizations, and appeals connected with new pharmacy benefit implementation projects.· Performed pharmacy claim… Show more Focused on ensuring the pharmacy benefit meet contractual and regulatory compliance.· Assisted pharmacy director to make sure key timelines, regulatory requirements and production levels are met for each pharmacy benefit or maintenance necessary to fulfill vital functions.· Acted as a point of contact to answer questions regarding benefits, claims, prior authorizations, and appeals connected with new pharmacy benefit implementation projects.· Performed pharmacy claim analysis directly to developed, implemented & monitored plan. Show less

Orlando, Florida Area

BeneCard PBF provides self-funded prescription benefit program administration with a personalized approach through focused, clinical expertise. Created, implemented training materials and documentation to support clients needs and our Medicare beneficiaries. I worked closely with CMS consultants to ensure company policies and procedures are align with CMS guidelines. Worked with the sales and marketing team to up sale and implement clients needs. Conducted training classes and account… Show more BeneCard PBF provides self-funded prescription benefit program administration with a personalized approach through focused, clinical expertise. Created, implemented training materials and documentation to support clients needs and our Medicare beneficiaries. I worked closely with CMS consultants to ensure company policies and procedures are align with CMS guidelines. Worked with the sales and marketing team to up sale and implement clients needs. Conducted training classes and account management to provided feedback to team members in both Commercial and Medicare Part D Show less

Miami, Florida

Bachelor'S Degree, Health/Health Care Administration/Management

Associate'S Degree, Pharmacy