Armando V. Email & Phone Number

San Tan Valley, Az, Us

Phoenix, Arizona, United States

● Assisted with setting up pharmacy network structure in Reclaims.● Audit of contract loads for adherence to quality measures and reporting standards.● Created documentation for standard operating procedures (SOP)● Provided client support on pharmacy claim investigations.● Audited work of others to identify and process / coordinate correction of loading errors.● Recommended methods to improve processes used by department.● Identified gaps and opportunities in network configuration.● Lead conversations with internal and external team members● Served as lead communicator for overall network configuration processes.● Provided technical, analytical, and strategic guidance to team members.● Lead cross-functional quality initiatives centered on improving the network maintenance process.

Phoenix, Arizona, United States

• Implementation of Commercial client specific coding within an RXCLAIM adjudication system.• Responsible for analyzing• Implementation of Commercial client specific coding within an RXCLAIM adjudication system.• Responsible for analyzing all coding and creating validation reports in SQL and investigating all inquiries from the audit team.• Responsible for extensive end to end testing on all pricing changes.• Handled all Pricing updates at plan level for networks, copays, accumulators, and price schedules.• Researching client benefit requests and recommending coding solutions to internal account management partners.• Lead all maintenance tasks for TPA / Commercial / Medicaid clients.Responsible for all large projects involving Vaccine implementation / reclassification of drugs. all coding and creating validation reports in SQL and investigating all inquiries from the audit team.• Responsible for extensive end to end testing on all pricing changes.• Handled all Pricing updates at plan level for networks, copays, accumulators, and price schedules.• Researching client benefit requests and recommending coding solutions to internal account management partners.• Lead all maintenance tasks for TPA / Commercial / Medicaid clients.Responsible for all large projects involving Vaccine implementation / reclassification of drugs.

Scottsdale, Arizona

Account manager for SilverScript Insurance a Medicare part D prescription benefit provider.• Silver Script Account Management CVS Health:• Silver Script Account Manager for open PDP with million beneficiaries.• Account manager for State pharmaceutical assistance program (SPAP). ● Analyzed client inquiries regarding routine client inquiries and provide timely and accurate responses. Research complex member issues and provide resolution in accordance with Medicare and Silver Script standards.● Partner with internal and external clients to achieve shared goals. Facilitate client meetings to provide status updates and issue resolution. Update prior authorization information in accordance with Medicare and Silver Script requirements.● Provide consultation and benefit expertise to internal partners. Maintain the monthly UM (BCF) mandated updates for MEDD. Work with both internal and external partners to ensure members, providers, and clients are financially whole.● Managed projects for clients with large claim and financial impact.● Perform comprehensive testing to prevent introduction of application defects into regression, end to end.

Scottsdale,Az

● Implementations for Medicare part D● Accurately research pharmacy claims for adjudication issues/reprocessed for Med D plans.● Implementation in RxClaim pharmacy claim adjudication system.● Analyze client benefit requests, determine best operational approach, and perform coding.● Validate coding accuracy utilizing various tools to ensure no financial impact or client/participant dissatisfaction. Responsible for meeting quality standards and performing testing and QA functions.

Tucson, Arizona Area

● Office of the president contacts for INTUIT. ● Resolve issues with chat and monitoring intra-day volume. ● Operational daily summary calls. ● Provide commentary that gives context into what is driving the call center metrics.

Tucson, Arizona

● Zonge Engineering Mineral and Hydrology exploration. Collected data samples for client data research and 3D modeling for proposed development. ● Performed analysis on energy facilities with both GDP and conventional methods. Lead teams on Seismic exploration and GPS/ Trimble work throughout the US Mexico and Alaska.