Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systemsIdentify and analyze user requirements, procedures, and problems to improve existing processesPerform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementationsIdentify ways to enhance performance management and operational reports related to new business implementation processesCoordinate with various business units and departments in the development and delivery of training programsDevelop, share, and incorporate organizational best practices into business applicationsDiagnose problems and identify opportunities for process redesign and improvement

Reviewed, implemented, and maintained organizations Policies & Procedures from different business owners.Attended management meetings (Compliance Committee) and discussed on development quarterly Risk Assessments and Action Plan (CAPS).Coordinated Ad-hoc compliance team for marketing season during the Annual Enrollment Period.Maintains rapport with regulatory personnel by arranging continuing contacts; resolving concerns.Conducted Oversight Audits on sponsors First Tier Downstream Entity (FDR) & delegates to ensure compliance with CMS regulatory statutes.Developed new protocols for audits and created excel audit tools that compile data to be examined by Chief Compliance Officer and to Delegation Manager.Handle the tasks of creating plan of correction, implementing and follow-up to Directors and cross-functional teams to ensure that compliance issues are solved.Internal Auditing & Internal Monitoring procedure by compiling and processing applications in compliance within CMS requirements.

Partnering with CVS Caremark and Catamaran/Optum Rx in resolving issues that arise during Point of Sale. Partnering with Formulary Department to ensure that our formulary is approving /denying the way they are programmed to. Validation testing for 2016 Caremark system. Routine attendance in implementation meetings with claims adjudication vendor to understand and document technical requirements and protocols. Proficient understanding of online entry of claims adjudication related eligibility information and its parameters and protocols required for customized client setup. Perform claim testing to ensure accurate claim adjudication. Research of plan/benefit design options and requirements as required. Daily monitoring of the Financial Information Report (FIR) transition.  Place technician coaching’s when necessary based off the Denied Claim Review (DCR) report. Experience with in-depth understanding of and develops ability to create and maintain plan/benefit design rules and limitations to include: Adjudication rules, Clinical rules, Payment rules, Client management, Plan/group management.

Trained to manage all line of business (Medicare/Medicaid )for the Wellcare.Validate New York letters, Hawaii letter, Illinois letter.Resolved Upper Management or Supervisor issues that arose.raining new hires and mentoring less experience employees.Lead my own Team and ensured that all task were completed in a timely manor.Experience managing internal / external customer disturbance.Verifying insurance benefits for commercial andgovernmental payers .Obtaining insurance authorizations in a timely manner for equipment/services provided .Handling inbound telephone and written inquiries from pharmacists and doctors.Screening and reviewing requests based on benefit plan design, client specifics, and clinical criteria.Providing information to clients, participants, pharmacists, and doctors regarding participants pharmacy benefits and drug coverage.Providing accurate procedures for medication exceptions.Facilitating resolution of drug coverage issues and proactively resolving issues.Maintaining accurate and complete documentation of all inquiries for continuous improvement.

the I-125 or PD-103 seeds making sure the activity meets the requirements.Responsible to load seeds into cartridges. Prepared product for Gamma and send product to the different hospitals.Verified patient information to ensure accuracy.Readied supplies for the following day's workload.Followed company procedures, schedules and routines.

Scanning prescription in and typing them.Filling the prescription and labeling it.Dealing with the patient.Customer service

Detailed and accurate with good client relation skills.Verified that the information on the prescription was complete and accurate. Prepared medication for clients through mixing, filling, verifying a prescription, counting pills, and labeling bottles.Priced and filled prescriptions; verified insurance coverage.Inventoried and stocked medication, sometimes including over the counter medicines and supplies.Prepared prescription labels, selected a prescription container, and affixed the prescription and other labels to the container. Established and maintained patient profiles and prepared insurance claim forms.Stocked and took inventory of prescription and over-the-counter medications, cleaned and helped maintain equipment, and managed the cash register.

Assay the I-125 or PD-103 seeds making sure the radioactivity level met the company's requirements. Ensure that the seeds are loaded accurately in the cartridges . Prepared product for Gamma radiation sterilization . Prepare the products for shipping to different hospitals. Verified patient information to ensure accuracy.

Scanning prescription in and typing them.Filling the prescription and labeling it.Dealing with the patient.Customer service

Ensured that each customer received outstanding service by providing a friendly environment, which included greeting and acknowledging every customer, maintaining outstanding standards, solid product knowledge and all other aspects of customer service. Maintained an awareness of all promotions and advertisements. Accurately and efficiently rang on registers and accurately maintained all cash and media at the registers. Communicated customer requests to management. Maintained orderly appearance of register area and kept supplies stocked. Any other tasks as assigned from time to time by any manager.