Marsalis W. Email & Phone Number

Detroit, Mi, Us

Lead contact and day-to-day administrator responsible for assigned clients with StrHighly engaged with the client and SAE from the transition of the client from Business Development, through the implementation process and throughout the client lifecycle.Document and keep all client and account information in Sales Force accurate and up to date.Interprets plan rules to ensure compliance with plan documents and summary plan descriptions (SPD) or summary or benefits (SOB).Analyzes utilization reports and assists SAE in recommending benefit plan changes.Submits plan change requirement for assigned clients in coordination with SAE.Researches and resolves client issues.Preparation of reports deemed necessary by SAE, RxBenefits Senior Leadership and or broker.Assist with the development of job aids, training materials, etc.Present a positive image in and out of the office to fellow employees, members, providers, and the community.Maintain clinical and benefit documentation and administrative paperwork according

Troy, Michigan, United States

Facilitates the operations of the Pharmacy Care Management Department by organizing, improving, and implementing pharmacy benefit management policies and procedures. Major areas of responsibility include oversight of the claims processing system, development of new benefit designs and programs, organizing the prior authorization process and management of the various vendor/customer relationships.

Facilitate the prior authorization process for Medicare Advantage enrolled members with HAP. Review and determine medication prior authorizations based on clinically appropriate criteria. Review claim adjudication reports involving rejected claims for Medicare Advantage members. Address grievances and appeals for Medicare and Dual enrolled member with HAP.

Process and review pharmacy prior authorizations for Commercially insured members. Answer incoming calls from client services, and doctors’ offices to initiate or check the status of submitted pharmacy prior authorizations for medications. Assist contracted pharmacies with adjudication errors and provide the appropriate resolution to pharmacy inquires.

Initiate prior authorizations for specialty medications, claim adjudication rejections, resolve reject billing claims, initiate patient assistance for qualifying patients, answer incoming calls and initiate outbound calls to providers offices for follow up care for patients, follow up calls to patients for prescription reminders.

Assist client’s providers with obtaining clinically appropriate medications for the client’s members via the prior authorization process•Answer incoming calls in the Pharmacy and Medicare Part D queue•Ensure accurate data entry and tracking of provider requests•Enter new prior authorizations from the fax queue in PBM & MCS•Collaborate with the client’s existing utilization review, case management, and member services staff to ensure appropriate resource allocation and utilization by all members•Assist in resolution of member issues related to pharmacy prescriptions•Act as a liaison between MeridianRx, providers, and the client•Respond to client requests for standard medication profiles/utilization reports•Have knowledge of commonly-used concepts, practices and procedures within pharmacy operations•Provide excellent customer service to all callers, at all times•Ensure compliance with all company, state and federal rules and regulations

Answer incoming phone calls, prepare intravenous medications using aseptic technique, deliver IV piggybacks to nursing units, and re-stock unit dose medications inside pyxis machines

Prepare chemotherapy/intravenous medications for adult/pediatric patients, assist in answering incoming phone calls, inventory, missing medications reports, and discovering methods throughout projects to facilitate the timelines of medications administered for nursing staff

for pharmacy technician program•Instructed pharmacy calculations and pharmacology and demonstrations for pharmacy practicum’s

Bachelor Of Business Administration - Bba, Business Administration And Management, General

Associate'S Degree, Business Administration And Management, General

Activities and Societies: Dean’s List, Commencement Speaker 2021 graduatePursing an Associate Degree in Business Administration.

Diploma, Pharmacy Technician

Activities and Societies: Deans List, Perfect Attendance

High School, Computer Science

Activities and Societies: Journalism, Poetry Society, Student News Broadcasting