Develop fraud, waste, and abuse logic as well as product enhancements on a pharmacy audit software tool. Maintain lasting relationships with all clients and ensure their contracted services are executed. Subscription contracted services include a solution tool, training, solution tool enhancements and SME advice on all advanced FWA cases and audit team processes. Full contract services include managing a team of auditors to meet desktop and onsite audit obligations on the clients’ behalf. • Account manage all clients for all audit needs and provide program consultation• Create algorithms for the development of clinical edits to aid in audit selections• Manage a team of auditors to meet contractual obligations and develop standard P&P’s to ensure team efficiencies• Create project plans for all new application enhancements and QA completed IT work tickets pertaining to new development and bug fixes• Research State and Federal pharmacy laws to maintain audit program compliance• Provide internal and external training for the audit application tool and for desktop and onsite pharmacy audits• Assist auditors with desktop and onsite audits as needed to meet deadlines

Researched and analyzed employer group’s pharmacy claim data against contract requirements. Provided detailed statistical audit reporting to clients for any anomalies found. Detailed audit and analysis based on rule guidelines around Step Therapy, Drug Coverage, Prior Authorizations and Quantity Limits.

Responsible for meeting contractual audit obligations and pursuit of new business. Detailed analysis of customer data to offer high level audit solutions to improve ROI and CMS compliance regulations. Ability to conduct intricate fraud cases and effectivly communicate with involved regulatory agencies. Responsible for fulfilling multiple customer needs and fostering lasting customer/client relationships.  Interim department manager  Project manager for audit process improvements Liaison/Account Manager between health plans, Argus and legal authorities for auditing needs  Creation of audit algorithims for identifying patterns of fruad Create documentation for process, policies, and procedures Negotiate and influence the sale/contract of audit services Conduct and schedule desktop audits as well as some onsite audits Provide detailed analysis on pharmacy claim activity Develop automated reports for audit detection in Access/Brio Maintain contractual audit agreements with customers and aid in directing those customers with the given information. Monitor and detect fraud, waste, and abuse with various resources Analysis of member’s drug therapy and pharmacies dispensing patterns. Prepare re-adjudications for anomalies found in both Medicare and commercial claim submissions  Provide customers with CMS regulatory demands and processes Set forth tasks and goals for the rest of the audit team Create team audit schedule Provide inter-departmental training for new hires

Provided patient healthcare service by preparing various prescriptions ranging from IV’s, TPN, inhalers, tablets, etc.Main responsibilities resided in the sterile/clean room environment for IV prescriptions and chemo therapy infusions.Trained new hiresStocked, maintained and offered technical support to Pyxis, (medication dispensing machine). Assisted the pharmaceutical buyer with ordering and receiving various products.

Assisted pharmacist with prescription entry and fillReviewed and maintained pharmacy inventoryProvided basic customer service needs