• Manage team of remote onsite pharmacy auditors • Manage On-Site Compliance audit services and also oversees contract with audit vendor. • Responsible to ensure pharmacy’s compliance with Part D, other government programs and network agreement. • Monitor and educate pharmacies on the operational processes based on their adherence to the pharmacy participation agreement and compliance with applicable State and Federal laws• Manage business relationships with pharmacy chain and affiliations relative to the audit process• Manage contractual obligations and performance requirements for all clients for the onsite audit process • Work closely with various areas within the organization, internal and external clients and auditors in complex research and response• Work with regulatory affairs in monitoring new legislation and proposed changes to existing legislation relating to pharmacy audit policies•Establish pharmacy audit policies and procedures to include ongoing changes within the industry and improve the processes to identify potential fraud, waste, and abuse•Made ongoing updates to improve and create the audit policies and procedure •Train new pharmacy audit staff on current pharmacy audit policies and procedures and support ongoing training of existing pharmacy audit staff•Developed new training materials and procedures related to software and audit programs •Researched Audit Claim Findings and Dispute error on audits conducted by vendor •Work collaboratively with external and internal IT teams to help develop and implement new audit software and architecture to provide data•Analyzed the feasibility of and developed requirements for new features and enhancements to Audit Software•Define, test and train staff on solutions implemented by software vendor•Act as a Project Manager for Retrospective Compliance Audit Program offered to help implement and develop process for new and existing clients•Serve as owner and admin of team SharePoint intranet site

Managed onsite audit processes on a daily basis Managed the timeliness and accuracy of pharmacy audit reporting to ensure timeliness of necessary client reportingMade ongoing recommendations to improve upon the audit process and procedure Help train new auditors on conducting audits and served as mentor.Worked closely with various areas within the organization, internal and external clients and auditors in complex research and responseResearched Audit Claim Findings and Dispute ErrorsAssisted with managing various projects as well as updating issues lists and status reports.Help developed new training materials and procedures related to software and audit programsAssisted in Creation/Implementation of new software utilized while performing Audits Work collaboratively with external and internal IT teams to help develop and implement new audit software and architecture to provide dataAnalyzed the feasibility of and developed requirements for new features and enhancements to Audit SoftwareDefine, test and train staff on solutions implemented by software vendorTracked and fully documents update requested for audit software

Keep Pharmacy Audit department informed of new federal and state regulations and sub-regulatory guidance related to On-site audit requirementHelped implement and develop new On-site Pharmacy Compliance Audit program based on regulatory requirements and contractual obligations Help train new auditors on conducting audits and serve as mentorManage the timeliness and accuracy of pharmacy audit reporting to ensure timeliness of necessary client reportingWrote an educational article for distribution to the pharmacy networkSuggested updates to Pharmacy Provider Manual related to Pharmacy Audit componentsWork closely with SIU, FWA, Desktop Audit, and Live Audit teams to identify emerging trendsMet with client representatives to ensure full understanding of Compliance AuditAssisted in Creation and Implementation of materials/tools utilized while performing Compliance AuditsIdentified Contracted Providers that posed imminent risk to clients and network for termination

Analyze and monitor pharmacy claims for over payment, fraud or abuse of Medicaid, Medicare, and Commercial claimsAnalyze documentation to determine the accuracy and completeness of clinical and financial information maintained in support of chargesRefer fraud claims to investigative unitsResearch and interpret State Board of Pharmacy LawsAnalyze documentation to determine regulatory complianceEnsure prescription drug claims are being paid in accordance with a pharmacy’s benefit manager contractResponsible for determination of accuracy of the prescription dispensing processUtilize Access, Excel and SQL queries to compile data for internal and external report and cost savings analysisConducted Ad Hoc audits per client requests

Assisted pharmacy manager with administrative dutiesResponsible for scheduling Pharmacy Team member Assisted customers by answering questions and addressing problems Assisted pharmacist by filling and processing prescriptions and updating patient and physician profilePrepared and processed third-party insurance claimsResponsible for scheduling and conducting the health screening Measured patients blood pressure, heart rate measurements, body mass indexConducted Cholesterol, Liver Function and Blood Glucose screening using standard finger stick protocolsOffered post-screening consultations

Established uniform policies, procedures, and work instructions to support 5S environmentLead employee and facilitated training in 5S and standardized work methodsUsed 5S tools to recommend methods to improve efficiency and improve customer response time and company marginInterfaced with employees, influenced them to engage in 5S philosophy and provided guidance as neededManaged and lead 5S initiatives throughout the pharmacy site to develop and support a culture of continuous improvementCommunicated and worked effectively with different levels of staff to drive processes with an emphasis on safe work practicesHelped ensure proper utilization of resource by applying the 5S modelDeveloped and delivered relevant training to facilitate and sustain improvement activities

Assisted customers by answering questions and providing information on procedures and policiesAssisted in the training of new customer service representatives and cashiersResolved customer complaints by taking appropriate action and following the company procedures and policesCalculated total payments received during a time period, and reconcile this with total salesServed in supervisory role as a trainer of new employees and in charge of Cashiers

Completed Carmine’s daily auditsVerified comp report, daily custom system sales detail reportVerified consolidated system time period summary report, and credit card batch transfer status reportVerified the separated checks (voids, comps, house charges) turned in and match the amount on the daily system tapeCompleted daily sales and tip share reports using excel Prepared and deposited daily cash Received and verified invoices and requisitions for goods and servicesPrepared and entered purchase ordersPrepared and processed batches of invoices for data entryCreated backup reports of invoices after data entry for general ledger Maintained listing of accounts receivable and payable