Development and implementation of departmental policies, SOP’s, internal process workflows and quality improvement initiatives for 7 industry leading specialty pharmacy call centersOversight of our Patient Care Services Manager I’s, Team Leads and over 70 individual contributors to ensure maximization of the organizations resources to exceed expected goals and metricsAct as subject matter expert and liaison for all pharmacy operation functions for key stakeholders including pharmaceutical brand teams, HUB Program and Client Account ManagersProvide measurable tracking and analytics to C-suite on performance KPI’s, PG’s and SLA’s using Power BI, Rhythm, Tableau, SQL, Microsoft Products, Salesforce, Domo, various AI platforms, SaaS models and Customer Success Management Business StrategiesEnsure Pharmacy compliance in accordance with all accreditation standards and regulatory bodies (URAC, CMS, ACHC, NASP and NABP) Successful account management of complex therapy programs for Oncology, Infusion, Multiple Sclerosis, HIV/AIDS, HCV, Hemo, Transplant, RA/OA and other biologics for clinical appropriateness and revenue cycle optimization

Coordinate sourcing and scheduling of 7 Clinical Field Nurses for Infusion, Specialty Therapy and Obstetric home nursing careReport and track timely submission of Clinical Field Nursing EMR and billing invoices to corporate Accounts PayableManage the Clinical and Administrative Intake Team to ensure payer reimbursement, benefit determination, coding and authorization adherenceSafely maintain standard of care continuum clinical team training Monitor inventory of Durable Medical Infusion Equipment for IV Infusion Therapy services

Direct daily operations for Mail Order Pharmacy front and back-end team of 16 Technicians and Supervisors utilizing ScriptPro, CPR+, CRM, Oracle, IEX and other healthcare platformsEstablish quarterly and annual department performance goals and participate in company quality improvement programsEnd to end accountability for implementation of best practices for Automated Dispensing System mail order pharmacy using change management techniques, CRM and IVR Obtained State of Florida Pharmacy Technician Registration

Lead a team of 30 Registered/Certified Pharmacy Technicians to comply with National/State Pharmacology law increasing team productivity by providing relevant training, interactive support and the creation of objective development plansEffectively supervise the Workforce Management Team using Avaya, CMS, Mattersight, NICE, Genesys Cloud, Mitel and Verint WFM software solutionsInstitute and facilitate the CVS Health Onboarding Technician Training Program for all new pharmacy techniciansChairperson of CVS Health CRGClient Services Team Lead Manage a team of 16 Financial Assistance Specialists dedicated to our manufacturer partners to provide brand support HUB Services and cost containment programsSecure procedural accounting in accordance with Advanced Care Scripts, Inc/Omnicare/CVS and manufacturer DED program guidelines Act as client-facing single point of contact for Pharma Programs, Plan Sponsors, Clients and patients with commercial and government sponsored lines of business

Conduct extensive quality reviews/audits to measure performance, compliance risk, offer actionable insight and identify potential process improvement gapsSupport targeted quality audit projects to increase patient satisfaction surveys results and guarantee a positive customer experienceProvide subject matter expert support on workflows, policies, system requirements/enhancements to significantly improve operational performanceManaged the Aetna Med D member’s transition from mail order or retail delivery platforms to our specialty pharmacy benefit designPharmacy Operations TrainerDevelop and facilitate training sessions to designated audiences based on role, function and responsibilityCollaborate with supervisors and managers to create curricula specific to the departmental needs as identified through individual contributors performance reviewsUtilize appropriate training interventions and other variables required to proactively improve business performance including shadowing, e-training and knowledgeable instructor-led trainingClaims Benefit Specialist Apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies and administer all cost containment measures to assist in the claims billing and collections processTriage and proof complex claims or reimbursement sources financial reconciliation, coding including diagnostic and procedure Internally perform post-payment analysis to ensure reimbursement accuracy and revenue management

Provide accurate eligibility determination and identify access solutions for patients with chronic diseases Proactively obtain prior authorization/precertification and determine medical necessity based on clinical documentation Track and reconcile complete revenue cycle management for dispensing specialty pharmacy