Patrick Biela Email & Phone Number

Boston, Massachusetts, United States

establishes and maintains relationships among the state's pharmacy program for drug and related services.Organize provider training sessions that provide rules and regulations education.Work with other agencies and stakeholders for pharmacy claims resolutions.• Conduct annual provider training management for pharmacists and technicians• Oversee call center services (resolving escalated tickets, providing training, and providing reporting• Evaluates and responds to claims processing discrepancies• Provide software vendor certification, pharmacy claim recovery, and new provider claim testing • Provides implementation support to new pharmaciesIs a mediator between pharmacies and software vendors for claim/system adjudication • Primary contact for pharmacists and pharmacy technicians seeking assistance with electronic pharmacy claims billingExecutes effective responses to all issues from the call center • Assists with drug rebate reporting and reconciliation• Performs drug rebate analysis • Performs claims adjudication and metrics analysis• Gives quarterly presentations to Pharmacy director and pharmacy teamIdentify and resolve operational problems using defined processes, expertise and judgment, and understand the upstream/downstream impactsIdentify, track, and monitor applicable performance metrics/trends

Boston, Massachusetts, United States

Examples of problems solved during tenure:1. took ownership of a borderline out of control process, Provider Service Center LTSS inbox, and significantly improved KPIs and communication frequency between MassHealth and providers.2. centralized, organized and standardized workflow for USPS and UPS correspondence3. reduced spending on workplace items by thoroughly vetting requests fornecessity. Used alternative suppliers for highest value.4. removed follow-up email waste for clinical reviewers and providers by developing and maintaining schedules for inquiries needing resolution.Process owner for provider inquiries regarding prior authorizations, Salesforce access, eligibility, enrollment, claims and appeals for the MassHealth Medicaid LTSS (long term support services) program. Ensured superior experience for providers and members. Identified ongoing needs of department and leveraged technology to develop new processes to achieve client and company business objectives. Improved resolution time by 57% within 6 months, 87% within first year. Achieved 97% satisfaction rate in 2020. Performed on average 2,500 outreaches per monthTeam lead for special projects such as COVID-19 Vaccine Scheduling Overflow Call Center, maintained a 98% resolution rate Supported operations for enrollment, claims, appeal and MMQ teams. Redesigned various processes.Demonstrated teamwork and collaboration with peers to complete tasks and resolve issues. Assisted team with provider questions and support managers by sharing insurance, conflict management, time management and operations knowledge.created process maps and run charts to support process improvementProcured resources, and ensured appropriate assets for team members while staying under budget. Purchased software licenses, executed employee terminations and onboarding of new employees

Boston, Massachusetts

Cambridge, Massachusetts

responsible for coordination of durable medical equipment including CPAP, biPAP and oxygenperforming patient outreach and consultation

Brighton, Massachusetts

In groups of 100-200, executed all Medicaid eligibility status checks via MMIS of Health Benefits and Department of Medicine patients prior to insurance renewalFollowed up on patient billing, enrollment status, registration and documentation requirements.Managed MassHealth correspondence for all health center patients covered under Medicaid

Greater Boston Area

SY '16-'17SY '17-'18Assisted in implementation of each student’s individualized Educational Plan and behavior plan • Performed data collection, performance tracking and revision of behavior plans• Provided assistance with instruction for autistic students assigned to a self-contained or integrated mainstream class• Supervised students during instructional and non-instructional classes

Boston, Massachusetts

Responsible for data coordination activities relating to enrollment and revalidation of LTSS providers. Responsible for managing and using clinical information to prepare official documents, database management, and provider research.

Boston, Ma

Progressively relied on for management of clinical operations of an ambulatory outpatient department.Accounted for nearly 60 percent of total patient volume from 2012-2016 and nearly 15,000 total patients Performed, troubleshot and interpreted various lung function tests on patients of all demographics in a fast paced hospital clinical practice. Maintained quality control policiesCoordinated department administrative support tasks such as report review, phone calls, scheduling, billing/insurance acquisitions, and maintained patient informationActed as liaison for healthcare providers and patients

Chicopee, Massachusetts

Responsible for all aspects of family owned business including customer service, cash handling, payment processing, inventory intake, assisted in marketing efforts. Assisted family in business succession and retirement plan after tenure ended.

Bachelor Of Science - Bs, Applied Exercise Science

Activities and Societies: Humanics in Action (2004-2007) Swim Team (2004-2007)This major emphasizes that physical activity is inextricably.

High School/Secondary Diplomas And Certificates

Activities and Societies: National Honor Society Swim Team (captain 2003) Epilepsy Awareness Month

Digital Marketing Strategy And Planning Specialization

Coursera specialization

Introduction To Business Specialization

Coursera Specialization

Investment Management Specialization

Coursera specialization

Introduction To Financial Accounting: The Accounting Cycle Specialization

Coursera specialization

Risk Management Specialization

Coursera specialization

Scrum Master Specialization

Coursera specialization

Agile For All

Kaizen Approach - Lean Methodology For Continuous Improvement