Melissa Ryan Email & Phone Number

Florida, United States

North Miami, Florida, Us

North Miami, Florida, Us

Us

Southeast Pharmacy Audit Analyst for OptumRx. Responsible for determining pharmacy audit risk by using analytical skills and audit tools. Completed onsite and desktop audits in order to rectify the risks identified. Professionally communicated with pharmacies to ensure 100% accuracy in the processing of claims and medications being dispensed.Achieved and at times exceeded yearly financial recovery goals by retrieving overpayments charged by pharmacies. Conducted audits to ensure compliance with Medicare Part D, Medicaid, State, and Federal regulations.Analyzed reports to collect and review data for the assigned region for case identification.Analyzed and monitored erroneous claims for potential fraud, waste, and abuse.Traveled throughout multiple states to conduct onsite audits and educate pharmacies on submitting accurate claims and compliance with state, federal and plan guidelines. Prepared and completed accurate reporting of audit findings.Communicated effectively with other departments to help coordinate activities.

Schaumburg, Illinois, Us

Responsible for completing onsite and desktop audits for southeast pharmacy territory. Determined pharmacy audit risk and completed audits by using analytical skills and audit tools. Scheduled and executed credentialing reviews/audits to meet and exceed personal, department and company goals. Performed credentialing review/audit of pharmacy to ensure compliance with company, state, and federal regulations.Conducted audits to ensure compliance with Medicare Part D, Medicaid, State, and Federal regulations.Interviewed personnel and conducted onsite observation unit functions, work performed, and methods, equipment, and personnel used. Analyzed pharmacy claims and invoices for inconsistencies and determine potentially fraudulent activity.Communicated with Fraud Waste and Abuse as well as other departments to help coordinate activities.Documented, prepared, and completed accurate reporting of audit findings.

In conjunction with the Director of Pharmacy, assisted in the training of other Pharmacy Technicians. Responsible for scheduling and conducting performance evaluations of Pharmacy Technicians as well as operating as a liaison between the intake department, pharmacy department, and sales force. Created a pharmacy technician training manual and assisted in developing standard operating policies, procedures, and practices consistent with company values. Hired, trained, and directed pharmacy technician staff members. Organized daily workflow. Compounded patients’ therapy inside an LFGI Glovebox within a cleanroom.Oversaw compounding of all IDPN, IPN, TPN and home infusion orders. Created and implemented an organizational chart for patient therapy compounding schedule.Entered and processed patient information and orders into CPR plus system. Organized patient charts and labels for compounding.Communicated with clinics by phone on a weekly basis to verify the patient’s status. Answered questions and requests from patients, doctors, and clinical staff and referred inquiries to the pharmacist. Ensured optimum customer service to patients, clinical staff, and doctors .to generate repeat and referral business.Liaison between the intake department, pharmacy department, and salesforceOrganized and prepared patient census reports, territory reports, commission reports, and quarterly sales reports for the Vice President of Sales and Marketing as well as the Chief Executive Officer.Created and managed holiday compounding schedules for patients and staff.Organized and ordered supplies.