Brian Bachman Email & Phone Number

Oversees a Center of Excellence client service team who serve as the point of contact for a mid-market Medicare Part D plan with Low Income Subsidy (LICS) alternatives, Individual (Chooser) and Employer Group Waiver Plan (EGWP) plans. Reviews cost trends and key performance indicators monthly and during the quarterly benefit review presentation that are used to identify potential products or services to partner with the client on for cost saving opportunities.Manages key complex projects and timelines, such as year-over-year client benefit changes and setup, through the coordination of internal business partnerships and analysis of benefit design options targeted to maximize client competitiveness and drive increased member satisfaction. Successfully leads and supports client request for proposal (RFP) new business and retention projects working together with internal cross-functional departments to develop answers and solutions to client requested new functionality and processesMentors and guides direct report’s independent development plans resulting in role alignments that increase engagement

Miami/Fort Lauderdale Area

Fort Lauderdale, Fl

Serves as point of contact and advocate between the client and company for a complex 250,000 live Medicare Part D plan operating in a US Territory that entails an Low Income Subsidy (LICS) alternative, Individual and Employer Group Waiver Plans (EGWP). Manages client implementation through communication and analysis of benefit design, performs logic configuration and testing of correct claim adjudication while maintaining all project timelines are met.Daily interactions with clients handling requests ranging from point of sale issue resolutions, eligibility issues, claims research and reporting inquires.

Brandon, Fl

• Owned and operated an independent health insurance brokerage specializing in senior products from Medicare Advantage, Medicare Prescription Drug, and Medicare Supplement plans. • Representing all major carriers in the Tampa Bay Area and surrounding counties including: Humana, Aetna, Cigna/Healthspring, Coventry, AARP United Healthcare and Wellcare. • Other products offered: Dental and Vision, Final Expense, Critical Illness, Hospital Indemnity, Long Term Care, and Whole Life.

Tampa/St. Petersburg, Florida Area

• Successfully marketed Medicare Advantage, Medicare Supplement, and stand alone Prescription Drug (Part D) plans to the current and ageing-in Medicare community via telesales opportunities, obtaining and confirming field agent appointments and seminars and through fulfillment kits in a federally compliant manner producing over $1 million in sales during the Annual Election Period. • Provided input and creative development of a center wide training and operating manual on Medicare Advantage Optional Supplemental Benefit products that has been adopted by the training department as a teaching and reference resource when needed for these niche products. This manual has since been digitized and is now included in the department wide Operation Manual. • Through inbound and outbound campaigns marketed Individual Dental, Vision and Financial Protection products through the use of cold and warm calling to prospects in order to meet and exceed conversion and production metrics. • Consistently meets and exceeds production goals and quality assurance standards

Tampa/St. Petersburg, Florida Area

• Receives via fax and phone, processes, and applies clinical criteria for prior authorization, non-formulary, step-therapy, quantity override, and tier exception requests from Doctor offices and members within set turnaround times varying from expedited to standard cases. • Obtains, organizes and applies clinical documentation including laboratory values for presentation to the Pharmacy Director and Medical Director while participating in the clinical and medical necessity debate on a daily basis. • Communicates with Doctor offices, pharmacies, and members in regards to Medicare Part D benefits. • Serves as subject matter expert for denied or rejected claims received at the pharmacy and works towards resolution for all parties involved. This includes reopening and resubmitting closed denied cases back to the Medical Director for reconsideration.

Tallahassee, Florida Area

• Lead a diverse team of Customer Service Representatives and Certified Pharmacy Technicians in the administration of Florida Medicaid pharmacy benefits by providing pharmacy and clinical support for the adjudication of claims and obtaining prior authorizations for non-preferred and clinical medications. • Monitored Avaya CMS to ensure agent availability and efficient use of time in order to meet and exceed service level agreements; instituted an after call limit of 1 minute per call average and a cascading break schedule to insure adequate phone coverage saving approximately $35,000 per year. • Independently examined and analyzed the team’s performance against measured service operational goals; identifies productive improvement areas and implements policy to increase productivity such as the use of pre-written fax back responses.• Served as subject matter expert on prior authorization criteria for non-preferred and clinical medications and claim adjudication logic to the call center staff, management, and the provider community. • Performed quality assurance reviews on faxed prior authorization requests and recorded or live calls in order to provide a high level of customer service and to maintain consistency among the call center staff. • Researched issues as assigned by the Contract Manager, Clinical Account Manager or the Agency for Health Care Administration in response to difficult inquiries including, but not limited to, authorization, payments, denials, coordination of benefits, and eligibility; interfaced with the customer and client by telephone, correspondence and/or in person to resolve concerns.

Tallahassee, Florida Area

• Identified prescription billing errors and contacted pharmacies to achieve a reversal of medications billed. Divisional goal of $350,000, personally recovered $500,000 within 4 months. • Compiled evidence of fraud and researched potential fraud candidates. Duties included researching provider's Medicaid application, pharmacists’ licenses and any recent claims filled by the provider.• Developed an evidence book according to internal guidelines, which documented the fraud. This evidence book was well received and was used in actual cases.• Created and maintained spreadsheets and documentation of fraud in the FACTS computer system. Re-organized existing spreadsheets for ease of use.

Tampa/St. Petersburg, Florida Area

• Received, processed insurance and filled prescriptions daily to be presented to the Pharmacist for review.• Reorganized the outpatient pharmacy so that drugs were more easily located and revamped the drug organizational procedure. This organization plan was well received and was also implemented in the main pharmacy, which resulted in a faster pull time, and less time spent stocking the shelves with an estimated savings of $35,000. • Maintained inventory control and developed a universal schedule and procedure for ordering drugs each day to make sure the pharmacy was stocked correctly. • Compounded specialty medications for patients.• Managed and serviced the Proscript prescription robot by restocking medication, vials, and following operational procedure.

Miami/Fort Lauderdale Area

• Assisted Pharmacists in daily activities• Received, processed insurance, and filled 500-800 prescriptions daily to be presented to the Pharmacist for review• Ran the pharmacy on the weekends during which the pharmacy was never backed up and work went smoothly.• Maintained inventory control and kept a clean work environment• Achieved Certification by the Pharmacy Technician Certification Board

B.S., Social Science

Education record