Mya K Email & Phone Number

Data and reporting for the Medical Pharmacy Underwriting team- Data extraction for analysis via code development/manipulation in SQL- Determine pricing for drug adds, removals, and client renewals through modeling, utilizing advanced Excel skills

Implement, analyze, and maintain pharmacy networks, network rates, and network structures in claims processing system, generate pharmacy network reports to assist with development of customized networks based on various client needs, perform routine system audits, and QC client set-up prior to system implementation.

Costa Mesa, California

User acceptance tester in the Business Process Management department to support the Prior Authorization System and the various components linked to the system. Worked extensively with multiple departments to review business requirements, assist in developing standard operating procedures, and test various system projects and enhancements prior to providing sign off for system execution.

Costa Mesa, California

Worked in the Prior Authorization department to respond to complex customer calls and resolve inquiries regarding member benefit and eligibility, billing and payment issues, physician assignments, and authorization for treatment while abiding by HIPAA and company standards, modified information bulletins to be distributed, and served as a subject matter expert in the training of newly hired employees.

(Gen-Rx Drugs, Rite Aid, NeighborCare, Inc., Walgreens, CVS)Accessed, inputed, and retrieved information from the claims processing system, resolved third party rejections and completed manual claim forms, processed prescriptions (including translation of SIG codes, product selection, counting and measuring drugs, and labeling of prescriptions), performed prescription pick-up procedures in adherence of company policies and procedures, and maintained drug inventory by utilizing various reports to maintain replenishment, in addition to pulling outdated, damaged, and recalled merchandise to be prepared for return.