Alison Mccarron Email & Phone Number

Philadelphia, Pa, Us

PBM Operations

Greater Philadelphia Area

Led the benefit design and implementation of all Medicare Advantage, Medicare-Medicaid, and PACE plans onto a new claims processing platformManage end-to-end testing initiatives of pharmacy benefits and clinical programsWork directly with clients to provide insight and recommendations on plan design and coding through the implementations process and continuing into daily operationsLead claims processing audits from driving the conversation during the live audit to responding to post-audit clarificationsLead weekly enhancement calls with the platform configuration team at our claims processing vendor to design complex processing logics – from defining business processing requirements to prioritization of system enhancementsAssist in clinical decision-making, including leading a project to redefine brand and generic processing using additional MediSpan indicators to allow for more accurate claims processing

Warminster, Pa

Working as needed fulfilling technician and customer service duties in an independent pharmacy focused on direct patient care, assisted living facilities, and specialty medical supplies.

Horsham, Pa

Prepared for audits as the pharmacy point of contact from initial request to the close of audit claims Assisted in creating a drug utilization review protocol to comply with URAC standardsDesigned and implemented a naloxone program for pain management patients to receive opioid deterrent medication to counteract accidental overdose at no cost to the patientCollaborated with the Director of Sales and Marketing to design a prior authorization pilot program with select practices in which I completed all prior authorizations for patients for prescriber review and submission, utilizing chart notes and ICD-10 coding

Greater Philadelphia Area

Helped the pharmacy seamlessly transition to a new computer and workflow system.

Bachelor Of Arts (Ba)

Activities and Societies: Vice President, National Society of Collegiate Scholars

High School