Danielle Thacker Email & Phone Number

Brentwood, Tn

Franklin, Tn

Implemented AWP pricing process that had never been utilized between two different vendorsReview each pharmacy’s chargemaster and update revenue and HCPCS codes as needed. Review contracts and monitor pharmacy practices to confirm vendor is meeting obligations Build or edit items in pharmacy systems as neededAssist with implementation of pharmacy systems for new acquisitionsSupport billing departments with rejected/denied pharmacy claimsParticipated in Operational Improvement Team events

Primary contact for all pharmacy related issuesSaved company over $10K a month during the first three months of employmentNegotiated and implemented contracts for new vendorsInvestigated and resolved CTM complaintsVery knowledgeable of CMS manuals and regulationsExperienced with CMS, AHCA, URAC, AAAHC auditsDeveloped policies and procedures for departmentExperienced with compliance, coding, billing, claims, audits customer service, and enrollmentDeveloped training material for other departments regarding Medicare guidelines and coverage limitsResponsible for auditing reports and oversight of providers for billing accuracy/fraudFormulary ManagementEvaluated Prior Authorization requests and entered medication overrides as appropriate to member’s coverage and criteria.

Investigate and resolve CTM complaintsVery knowledgeable of CMS Prescription Drug ManualSaved company over $10K a month during first three months of employmentInvestigate and resolve CTM complaintsVery knowledgeable of CMS Prescription Drug ManualIdentified and helped correct costly eligibility update errors Formulary ManagementEvaluate prior authorization requests and enter drug overrides as appropriate according to members’ criteriaCommunicate with providers regarding possible drug alternatives, preferred medications, and members’ current drug regimeExperienced with billing, claims auditing, customer service, and enrollment Arrange meetings with providers to discuss and resolve issuesPlan Pharmacy and Therapeutics meetingNegotiated and implemented contract for new vendors

Evaluated Prior Authorization requests and entered medication overrides as appropriate to member’s coverage and criteria Developed policies and procedures for new departmentResponsible for moderating and updating interdepartmental website Communicated with physicians regarding denials, possible drug alternatives, and formulary

Voted Preferred Lead Tech by pharmacistsRestocked and repaired pyxis machinesPrepared IV AdmixturesTriaged phone calls for pharmacistsCompounded oral solutions, ointments, and creamsMeasured drugs according to ordered dosePrepackaged Bulk medicationsAssisted in training new employeesInventory Management

Diploma

High School Diploma