Heather Ashbaugh Email & Phone Number

Madison, WI, US

Dayton, OH, US

• Responsible for External Regulatory Audit Management.
• Supports and coordinates external audits conducted by regulators of Medicaid, Marketplace, Medicare programs.
• Minimizes risk to the company by responding to, supporting and assisting with facilitation of audits with the Federal Compliance Officers in the execution of the audit.
• Coordinates and directs all responses and follow-up to audit findings and draft audit reports.
• Monitors follow-up action plans on audit findings.
• Supports the education and training of audit protocols for internal and vendor partners.

Dayton, OH, US

• Responsible for organizing all internal and external audit findings, oversight statistics, and other operational monitoring results to maintain pharmacy compliance dashboard.
• Coordinate pharmacy Subject Matter Expert (SME) participation in federal and state contract audits, regulatory audits, and site visits.
• Responsible for triaging requests, tracking, and coordinating assignment of audits, escalations, regulatory distribution, required reporting, and investigations tasks to the appropriate team member or leader for.
• Assist CareSource Medicaid Fraud Control Program Integrity teams by gathering information from Pharmacy Benefit Manager (PBM) for OIG/RFI audit pharmacy claims data requests.
• Conducts Pharmacy Monitoring and Oversight to ensure compliance and readiness to satisfy CMS and NCQA accreditation requirements.

Dayton, OH, US

• Responsible for reviewing non-formulary prior authorization requests for CareSource providers and educating them on resources outlining formulary alternatives.
• Load prior authorization fax requests and approve as appropriate in the CAS/Client Access systems, ESD/C360 systems.
• Initiate process for routing prior authorizations requiring review by a pharmacist.
• Provide training and guidance on processes and procedures to new team members.
• Cross-train interdepartmentally for all Medicaid and Marketplace products.
• Assist Case Managers and Member and Provider Services with pharmacy issue resolution.

Kettering, OH, US

• Responsible for assisting Pharmacist with clerical duties associated with managing specialty pharmacy focused on dispensing oral Chemotherapy medications.
• Work with financial counselors/advocates to find and process grants through cancer foundations and/or drug manufacturers.
• Process monthly medication dispensing reconciliation and sales analysis reports.
• Create training documents for new team members. Provide training and guidance on processes and procedures to new team members.
• Assist in comprehensive care to patients by communicating with doctors and nurses regarding patient medication concerns.
• Helped build Pharmacy, which started as a physician dispensing program, into a specialty retail pharmacy.

Dayton, OH, US

• Competent in all areas of the pharmacy (outpatient, inpatient, IV room, and Pyxis fill).
• Patient services including customer service, processing, filling, and checking out prescriptions with the QS1 data entry system.
• Used a POS (Point of Sale) System.
• Daily medication delivery to the floors.
• Proficient in pre-packaging liquid and tablet medications for unit dose and patient specific dosing with Medi-dose.
• Compounded oral solutions, suspensions, capsules, and sterile intravenous medications.

Woonsocket, Rhode Island, US

• Prepared and bottled medications.
• Deciphered and entered prescription data into the pharmacy information systems.
• Processed insurance billing and reimbursement.
• Effectively resolved insurance rejections and other billing issues.
• Basic knowledge of medications and uses.
• Trained as an inventory specialist.