Facilitate enrollment and compliance for a Federal Healthcare Exchange Insurance plan.• Review 834 File for Errors• Assist in the economization of Health Plan workflow – Document Intake• Advise and assist on the implementation of IVR payment platform – Premium Collection

Ensure internal IT and business needs are clearly identified, designed and constructed to meet quality standards for our client (Mail-Order Pharmacies).• Project Manage all aspects of the Software Development Lifecycle (Scrum Methodology) o Troubleshoot and draft ticket requests to enhance the pharmacy ERP...Operations, Billing, Dispensing, Inventory Management and ERA/Payment postingo Manage Pharmacy Ticket system: absorbing, reflecting and drafting user requests for pharmacy ERP• Vendor Discovery and Management: Pharmacy Switch Operators (RelayHealth), Electronic Prescription Network (Superscripts) Rx Clinical content delivery (Cerner Multum) and IVR telephone payment system (Forte Payment).• Technical and Legal Research: NCPDP (D.0, SCRIPT and ORT) and ASAP 4.2 Standards for Prescription Monitoring Program and ISTOP/PMP New York

• Claim/Audit Denial Analysis: Diabetic Testing Supplies, Orthotics, Incontinence and CPAP • Appeal Medicare Part B and C audits, denials and payment disputes (claims)• Track billing, payments, remittance and denials of Medicare Part B and C claims• Research payment resolution for outstanding claims• Construct and analyze data to increase efficiency on payor procedure • Comply with all CMS contracted auditors/facilitators/QIC

• Claim/Audit Denial Analysis: Diabetic Testing Supplies, Orthotics, Incontinence and CPAP • Appeal Medicare Part B and C audits, denials and payment disputes (claims) • Track billing, payments, remittance and denials of Medicare Part B and C claims • Research payment resolution for outstanding claims • Construct and analyze data to increase efficiency on payor procedure • Comply with all CMS contracted auditors/facilitators/QIC

Required to meet prompt deadlines • Ensured ICDRI’s message was preserved in all written content • Experience with MLA…APA…CMS…Turabian writing style

Provided logistics between ICDRI and Federal Employee to reestablish technical education Section 508 training