Benjamin Earle Email & Phone Number

Charlotte, Nc, Us

Analyzes and monitors industry publications and press releases to be aware of fraud, waste, and abuse (FWA) schemes (HPMS FWA-AICE, NHCAA, HHS-OIG, DOJ, etc.) impacting pharmacy business.Performs onsite and desktop investigative audits targeting potential Pharmacy FWA Adheres to all applicable requirements for case process and qualityPrepares reports and presentations based on case resultsConducts onsite audits at pharmacies to assess physical premises, compliance with regulatory requirements, and completeness of recordsCollaborates with the team to support overall FWA prevention and detection e!orts and ensure case qualityWork on special projects as assignedProvides ideas and recommendations on process improvements

Oversaw main operations surrounding data input and processing to maintain high accuracy and ensure compliance with company policy and regulations. Maintained efficient systems to confirm the prompt release of accurate information across a range of diverse clients. Supervised intake of program-specific information through the mail, fax, and electronic documents, and responded to appropriate parties. Proficiently logged information in suitable databases and triaged program-specific mail to program associates.Enhanced overall performance by leveraging professional relationships with associates and management while cultivating and maintaining a productive environment.Highly acknowledged as Top Performer throughout 2021 for outperforming others and effectively managing and executing key procedures across various functions.Led, trained, and guide high-performing teams of competent professionals via conducting skill-developing training sessions, empowering members through task delegation, and supporting the delivery of challenging goals.Ensured availability of pharmaceuticals for financially vulnerable populations through defined programs and SOPs.

Charlotte Metro

Directed key functions related to strategy implementation, vendor contracting, regulatory compliance, tradeshow attendance, client networking, and revenue stream analysis, across six locations with over 18 direct-reports. Conducted monthly store visits to ensure store progress on time and in accordance with strategic direction. Supervised claim correction, third-party coordination, and internal auditing. Analyzed market to assess reimbursement trends and uncover new revenue streams. Ordered vaccines across all locations based on the analytical forecast.Boosted performance by training, developing, and leading 70 employees through day-to-day guidance, defining deliverable goals, offering constructive feedback, reinforcing efficiency goals, and recommending improvements.Successfully led business growth by increasing the number of stores from two to six in a span of three years via acquiring independent pharmacies and standardizing operations across the chain.Drove business success by executing effective initiatives including on-site PBX to VoIP conversion, Windows server Infrastructure implementation, and employee handbook/procedures/policies development.Enhanced overall efficiency by integrating advanced technology systems including computer-assisted ordering and perpetual inventory management system, Zenefits employee-management system, chain-wide accounts receivable system, inventory transfer system, and cloud-based scheduling, time, and attendance.Navigated incorporation of the CQI program, company-wide email and collaboration system, and industry-appropriate information security policies.

Spearheaded activities surrounding filling prescriptions, counting pills, developing employees, and ensuring superior customer service. Conducted third-party claim analysis to collect claims/chargebacks and assess targeted areas. Led customer service functions including processing and correcting claims, reviewing and processing insurance benefits, and maintaining accurate data. Trained, led, and developed a team of seven technicians to deliver KPI and corporate goals.Confirmed information regarding prior authorization, step therapy, follow-up correspondence, and formulary requirements via collaborating with patients and prescribers.Optimized service delivery and nurtured exceptional customer experience by collaborating with strategic partners including patients, physicians, nurses, insurance companies, and managed care organizations.Delivered a significant saving across a poorly-performing branch by uncovering and alleviating inefficiencies and bottlenecks, reducing $1.2M worth of inventory, and training pharmacy managers, pharmacists, technicians, and drug clerks on best practices and standards operating procedures.

Rock Hill, Sc

Health/Health Care Administration/Management

Biology, General