Monitor Avaya CMS, FIVE9, CAS offline queues, and Verint WFM to ensure appropriate staffing levels and service levels are met.Adjust staff and schedules to maximize employee efficiency and assist with forecasting/scheduling call center functions within multi-skill/multi-site environments.Research and support operational staffing adjustments to meet performance goals.Create and maintain data in CMS, Verint WFM, and other databases as needed.Participate in meetings with business partners and team to discuss workflow/scheduling concerns and staffing changes.Utilized Aspect and Avaya Predictive Dialer to monitor volume of inbound and outbound calls, faxes, and offline functions.Adjusting workflow/skills and staff/schedules to ensure service levels and performance goals are met.Providing and maintaining reports/data in databases and resources such as Verint WFM and Aspect.Maintaining correspondence with business partners and team in a professional and timely manner.Review waitlisted PTO for additional approvals and maintaining system maintenance of employee new hires and terms.

Responsible for efficient and accurate work management and timely prioritization of Specialty medication prior authorization referrals reviewed by the Case Review Unit for the Specialty Guideline Management Programs. The role provides support to the Prior Authorization Department in meeting client expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making. Responsible for maintaining compliance with ERISA, CMS, and client specific requirements. The responsibilities included will be ongoing monitoring of staff performance metrics, responding to required client QA reports, and provide recommendations for operational improvements. This position will also require providing direction and maintaining the responsibilities of Technician levels I, II, and III. This position will also act as a conduit between the Case Review Unit and the Specialty Guideline Management Clinical Team for providing updated program protocols.

Processing and communication of Specialty medication prior authorization referrals reviewed by the Case Review Unit for the Specialty Guideline Management Programs. This position collaborates with Customer Service, Benefits Verification and Pharmacy Operations to communicate referral status and determinations. This position is also responsible for fax processing and providing telephone call assistance for prescriber office staff, pharmacies and members based on program criteria. Maintaining complete, accurate and timely documentation of all appropriate information is necessary. This position also works closely with the Case Review Unit Clinician team for clinical support on daily functions.

Perform administrative tasks to support team members with clinical pharmacy services as needed.May act as a central contact for the clinical team for designated project communications, correspondence and associated documentation.Prepare, handle, distribute, file, and archive clinical documentation and reports.Review of study files periodically for accuracy and completeness.Prepare, handle and distribute of Clinical pharmacy supplies and maintenance of tracking information.Sitting or standing for extended periods, telephone conversations, use of electronic mail, writing letters and memos, face-to-face discussions with individuals or teams, contact with others, conflict situations, making decisions that impact the company, being exact or highly accurate, meeting deadlines, coordinating or leading others, work with external customers or the public, work with others in a group or team, responsibility for work outcomes and results, responsibility for the health and safety of others.Strong Computer skills including proficiency in use of Microsoft Word, Excel and PowerPoint.Strong written and verbal communication skills.Effective time management and organizational skills.Attention to detail and accuracy in work.Strong customer service orientation.

Healthcare management accessing copay assistance for all nationally recognized insurance company.Implementation on new training and facilitating materials to all new hires.Responsible for informing staff of any changes, updates, etc., regarding admissions; discharges, visits, schedules; and clinical meetings as directed by the Administrator/Clinical Supervisor.Process insurance verification and authorization Ensures clinical record systems are maintained in compliance with state, federal and Joint Commission regulations.Protects all clinical records through the establishment and implementation of control procedures for all open and closed records.Protects the confidentiality of patient and organization information through effective controls and direct supervision of clinical records.Gathers, collates, and reports referral statistics including key customer referral trends.Special projects and other related duties as assigned by the Administrator/Clinical Supervisor/Office Manager.

Assist clients via virtual registration for our 4k locations world-wide. Provide upmost customer service for all clients and staff.Welcoming our patients and family members in a professional manner.Answering patient and visitor questions.Contacting the nursing staff for emergency medical needs.Interviewing incoming patients and accompanying responsible individuals to move through the registration process quickly and efficiently.Explaining policies clearly to the patient.Ensuring necessary signatures are obtained for treatment, verifying insurance and obtaining precertification/authorization.Calculation and collection on patient liable amounts.Processing patient charts according to paperwork flow needs and established productivity standards.

Tutoring / Community Outreach

Team player, Help pharmacy when short staffed.Marketing/Sales to Infectious Disease Physicians.Reported directly to CEO and President and Pharmacist.Create events, promotions for the Specialty Pharmacy.Create a good report with my patients and clinics.Handle all HIV/AIDS Patients.Customer Service calls for Infectious Disease Physicians.Escalated calls.Educate patients on Medication and insertion on meds.Inventory for Pharmacies.Insurance verification, Insurance set-up for Pharmacy.