•Maintained document control in order to provide evidence of conformity of requirements and of the effective operation of the quality management system, including the initiation and implementation of Change Requests •Performed internal audits to access the quality system structure against criteria defined in the quality policy, applicable regulations, and recognized international standards (ISO) •Assisted with the facilitation and execution of customer audits •Creation of… Show more •Maintained document control in order to provide evidence of conformity of requirements and of the effective operation of the quality management system, including the initiation and implementation of Change Requests •Performed internal audits to access the quality system structure against criteria defined in the quality policy, applicable regulations, and recognized international standards (ISO) •Assisted with the facilitation and execution of customer audits •Creation of Corrective and Preventative Action Plans to eliminate, and/or reduce the risk of actual or potential non-conformities•Initiation and implementation of Document Change Requests•Served as an implementation team member for the new Material and Resource Planning Software•Performed tool studies to increase tool life and decrease machine downtime while looking for cost saving opportunities Show less

•Counsel prospective applicants on the admissions process; including opportunities available at Chatfield College•Provide one-on-one admissions counseling to diverse populations•Timely planning and implementation of recruitment activities for assigned high schools and referring agencies within assigned territory•Maintain accurate contact records and tracking data of inquiries throughout the entire admissions process•Assist in the development and successful delivery of on-campus… Show more •Counsel prospective applicants on the admissions process; including opportunities available at Chatfield College•Provide one-on-one admissions counseling to diverse populations•Timely planning and implementation of recruitment activities for assigned high schools and referring agencies within assigned territory•Maintain accurate contact records and tracking data of inquiries throughout the entire admissions process•Assist in the development and successful delivery of on-campus events and programs for individual students and groups Show less

•Worked with appropriate functional areas across the organization to obtain support for audit activities•Provided required documentation including benefit information, pricing, DUR and all other agreed upon information to the audit coordinator and/or external third-party auditors•Communicated audit findings and discrepancies to functional areas•Ensured extensive research was conducted to prove claims were paid accurately

•Served as point of contact for internal health plan audit coordinator and/or external third-party auditors•Worked with appropriate functional areas across the organization to obtain support for audit activities•Provided required documentation including claims extract, benefit information, pricing, DUR and all other agreed upon information to the health plan coordinator and/or external third-party auditors•Communicated audit findings and discrepancies to functional areas•Ensured… Show more •Served as point of contact for internal health plan audit coordinator and/or external third-party auditors•Worked with appropriate functional areas across the organization to obtain support for audit activities•Provided required documentation including claims extract, benefit information, pricing, DUR and all other agreed upon information to the health plan coordinator and/or external third-party auditors•Communicated audit findings and discrepancies to functional areas•Ensured extensive research was conducted to prove claims were paid accurately Show less

•Served as primary liaison between the customer and all functional areas of APM •Served on the implementation resource team for new business and pharmacy program conversions/implementations•Supported sales and broker presentations •Provided customer training for pharmacy program roll-out and clinical initiatives•Provided both on-site and off-site client support including custom benefit management system training, researching and resolving phone and written inquiries, resolving… Show more •Served as primary liaison between the customer and all functional areas of APM •Served on the implementation resource team for new business and pharmacy program conversions/implementations•Supported sales and broker presentations •Provided customer training for pharmacy program roll-out and clinical initiatives•Provided both on-site and off-site client support including custom benefit management system training, researching and resolving phone and written inquiries, resolving claims, benefit, and eligibility issues•Performed root cause analysis on issues related to pharmacy adjudication process, reporting, eligibility interfaces and data transmissions•Provided product support by assisting in strategic planning, specification development and system design for customer requested system enhancements•Facilitated operational and communication processes with each new business implementation Show less

•Managed all pharmacy contract set up within the claims processing system (PHI/ProPBM)•Negotiated contracts with independent pharmacy chains•Analysis of claims data to validate application of appropriate reimbursement rates•Oversight of operational processes including maintenance of the Pharmacy Contract Management System (PCMS) •Managed GEO Access Analysis for company Request for Proposals•Resolved escalated pharmacy inquiries from all departments •Represented Provider… Show more •Managed all pharmacy contract set up within the claims processing system (PHI/ProPBM)•Negotiated contracts with independent pharmacy chains•Analysis of claims data to validate application of appropriate reimbursement rates•Oversight of operational processes including maintenance of the Pharmacy Contract Management System (PCMS) •Managed GEO Access Analysis for company Request for Proposals•Resolved escalated pharmacy inquiries from all departments •Represented Provider Relations on the implementation resource team for new business and pharmacy program conversions and implementations Show less

•Conducted 20-30 pharmacy provider field audits per month •Analysis and presentation of audit findings to Retail Network Director and Special Investigations Unit•Managing monthly audit/travel schedule•Analysis and decision-making authority for pharmacy rebuttals

•Provided operational and HBS Order Entry and Dispensing system training to all pharmacy technicians •Designed and created the Anthem Rx technician training manual•Participated, as a core team member, in the mail order process improvement initiative which resulted in the acquisition of a new facility with technologically advanced robotic fulfillment capabilities•Primary technician responsible for the reconciliation of paid claims data