Mike Ramirez Email & Phone Number

Miami, Fl, Us

Richardson, Texas, Us

Collaborate with business leadership, IT development teams to support and enhance Smart Rx Assist Copay Maximizer operation.Develop efficient reporting processes, ensuring timely delivery of daily, weekly, and ad hoc reports to management.Engage in client integration meetings, gathering key IT requirements to drive successful onboarding and implementation.Conduct comprehensive data validation for inbound client eligibility, PA, and claims data, maintaining high standards of data integrity.Manage client ID, customer ID and coverage code information on the Multiclaim/AS400 iSeries platform, for seamless data processing.Perform in-depth analysis of inbound raw data transfers, resolving discrepancies with DB2 tables to enhance overall data quality.Collaborate with Clinical Director to audit HCPCS & NDC drug codes, ensuring compliance and accuracy in drug list management.Provide critical support to Client Services Director in identifying data discrepancies and uncovering new ASO groups additions.Support Operations team in troubleshooting claim data anomalies and unusual eligibility discrepancies improving claims maximization.Develop complex SQL code to extract essential group roster, HCPCS/NDC codes, member, drug name and drug program information.Led data quality assurance initiatives, utilizing advanced Excel functions to maintain data integrity and reliability across platforms.Support project management teams in onboarding five new health plan clients, developing comprehensive test strategies.Participate in daily stand-up meetings with IT development and leadership teams, utilizing JIRA to track break/fix production support issues and manage MI/MD tickets with accurate time tracking tasks.Produce detailed technical specifications documents for AS400 iSeries/Multiclaim and Member Outreach Application.Maintain weekly rejection reporting and actively monitored inbound claims to quickly identify and address potential issues.

Us

Collaborated closely with stakeholders and leadership to drive test transformation reporting initiatives and continuous improvement.Managed monthly Go Live incremental and daily pharmacy claim reporting using VBA Excel Macro for both new and existing clients. Provided critical support to the Pharmacy Finance team, delivering daily Pharmacy network pricing reporting and effectively managing network falloff and resolving double network scenarios.Developed complex SQL code to extract essential plan code information, such as carrier, account, group, MAC schedule and BPL.Demonstrated expertise in issue resolution by creating and managing Rx Construct and Service Now tickets, addressing network errors and internal data transfer issues create by ACIS process. Produced comprehensive reporting dashboards and scorecards enabling monthly/quarterly monitoring of internal metrics. Contributed to new client implementation success by creating various Power Bi Desktop reports using multiple data sources.Utilized intricate SQL coding to generate Performance Guarantee and Manual Claims dashboard reports.Ensured data integrity and quality assurance maintenance through proficient use of Rx Claim, Rx Comet and Rx Surveillance tools.Led testing project management for onboarding three new large employer groups and one health plan new client implementations, developing a comprehensive test strategy and coordinated test execution across workstream teams. Developed test scenario templates and internal workstream dashboards to facilitate efficient test execution and reporting.Prioritized internal development work to maintain schedules and allow ample time for functional and internal testing.Spearheaded functional unit testing for claims extract, claims compare/parallel and end-to-end testing.Actively participated in agile process improvement meetings with IT teams, utilizing AHA and Rally to create new features and stories.

Bloomfield, Ct, Us

Provided essential support for business analysis and application maintenance in the Pharmacy & Utilization Management departments. Reviewed business requirements and analyzed data sources from MS SQL server for design, development, testing and production rollover of reporting, dashboards, Stories and KPI scorecards within Tableau Desktop.Played a pivotal role in the 2020 roll-out of the Express Scripts Pharmacy Claims Benefit Management integration project, focusing on data mapping and data migration to multiple SQL database tables.Analyzed complex designs and prepared application/system specifications for information systems solutions, catering to user acceptance testing (UAT) and deployment.Ensured compliance with regulatory reporting requirements to CMS, Medicaid, HIPPA, PHI, CIP, HEDIS, Medicare advantage and audits.Assisted in the creation of user documentation, policies and procedures that impact user applications. Communicated IT design concepts to all stakeholders to facilitate the implementation of solutions aligned business objectives.Wrote SQL code on MS SQL server to resolve intricate technical systems issues and optimize system performance. Created ad-hoc queries and reports as requested and provided ongoing analytical support for these requests.Developed business specification requirements, technical design and solution overview documentation.Worked with Utilization Management to create and produce a new Part B drug report on weekly subscription SSRS package.Collaborated closely with Pharmacy department to update and enhance over 70 reports with new tables and new SQL logic.Performed testing validation, daily monitoring/troubleshooting of data issues in support of project application support plans. Documented existing and new business processes and workflow data mapping of complex tables, files and records.Used TFS for creating epics, features, user stories and tasks along with HSPM change management for deployment.

Miami, Florida, Us

Utilized advanced business intelligence tools and MS Excel for daily, weekly, monthly and ad-hoc reporting for senior management. Wrote SQL code on MS SQL server database to add new users, resolved technical systems issues and routine system maintenance. Reported financial performance, KPI and sales projections to top executives on key sales metrics by product line, region and units sold.Conducted research to uncover key issues, benchmarks, and best practices and synthesize findings into recommendations.Analyzed business performance scorecards with specific commentary focused on business drivers, performance trends and risks.Set up and maintain national tracking and KPI’s based on a specific predetermined formatted tracker.Analytical support to corporate and regional teams as required for supplier reviews, business reviews, and performance management.Worked with business in creating new interactive Tableau Dashboards and Scorecards.Created, modified and optimized Tableau reports, dashboards and stories and publish the reports to the Tableau servers.Performance tuned Tableau reports and underlying data for increased performance.Provided training and support to business users on the use of Tableau interactive web reports and Tableau Dashboards.Developed and documented standards for best practices for development and administration of Tableau Reports.

Miami, Fl, Us

Significantly increased annual sales revenue from $1.6 million to over $5 million. Successfully collected over 90% of outstanding accounts receivable.Reduced material cost by over 30% through efficient purchasing and accounts payable expenses.Wrote SQL code on MS SQL server database for data analysis and reporting.Used Tableau desktop to create dashboard, data visualization and stories for analysis and reporting.Created weekly and monthly reports in Excel using advanced excel functions and macros.Expanded public relations, communications and marketing campaigns with Google Analytics and SEO companies, coordinated special events and metal roofing seminars, interacted with current and potential customers, retained & established new clientele, coordinated and managed export orders to the Caribbean and Latin America.Performed financial planning by managing business expenses.Created business requirement document, functional requirement document and process run book.Project management using agile/scrum methods, ERP implementation, planning, scheduling, user testing, budgeting and quality control. Supervised and managed daily operations and work assignments of 20 employees.

Miami, Florida, Us

Forecasted airline space by region and managed over 50 million dollars of airline expenditure for Royal, Celebrity, Azamara.Prepared detailed weekly and monthly Excel and PowerPoint analysis of airline costs by product and region.Wrote SQL codes on Oracle database for QA, reporting and analysis.Involved business and functional requirement documents, data mapping document in collaboration with different teams within RCCL.Produced decision support tools to maximize use of airline space and reduction of costs.Implemented processes to improve overall procurement and gateway sourcing for Air/Sea & Revenue Management.Main lead in processing and loading new Air Deployment into AS 400 for all sailing’s for 2011-2012 seasons.Generated reports, updated and created Air Standards for over ten markets, including Alaska and Europe.

Tampa, Fl, Us

Managed human resources, employee benefits, employee payroll and maintained personnel records. Collected over 85 % of outstanding accounts receivables and maximized accounts payable functions. Performed public relations and customer service, including coordinating projects and events, interacting with current and potential customers, retaining and establishing clientele. Achieved optimal financial administration, such as office budget and expenses, prepared and analyzed monthly financial Profit & Loss statements and expense reports, completed labor distribution reports.Supervised branch operations with 34 employees.

Bachelor Of Science (B.S.), Hospitality Administration/Management

Associate'S Degree, Business Administration, Management And Operations