• Manage and report the daily audit of the Pharmacy Help Desk • Monitor trend reporting for the Pharmacy Help Desk• Ensuring the accuracy of paid Medicare pharmacy claims• Daily audit of pharmacy prior authorization denials• Co-Manage and report Magellan approval and denial correspondence• Manage the completion of the Long Term Institutionalized Report• Completing Transition letter accuracy at 100% • Extensive knowledge of the Pharmacy Help Desk policies and procedures• Identified corrections in the Medicare Help Desk Standard Operation Procedures• Extensive knowledge of the Pharmacy Prior Authorization policies and procedures• Successfully completed the Management Fundamentals Program as the first in Independent Health history• Successfully completed the Career Pathways Program in 2015• Extensive knowledge of Commercial Benefits, Medicare, State Products, Coordination of Benefits, Claims Adjudication, CPT, ICD-9, ICD-10, Worker’s Compensation and No Fault• Certified as a SharePoint Site Owner• Maintain the privacy and security for all members• Consistently deliver the “Red Shirt Treatment” and living the Core Values of Independent Health

• Manage the Document Processing quality assurance review for Operations, including Mail Preparation and Medicare• Successfully identified more than $1,945,872.00 in incorrect payments in 2016• Manage and report daily quality audit of System Quality Assurance in FormWorks at 100%• Initiated the update of Mail Preparation’s Standard Operating Procedures• Identified corrections in the Physician Standard Operation Procedures• Coordinate the 86 Audit Project each week• Co-manage the Model Audit Review• Co-manage our Quality Assurance SharePoint site• Successful in meeting or exceeding department goals including 99% of new claims paid in 30 days, 98% of new claims adjudicated in 14 days and 9 or less average days to adjudication• Complete monthly Outstanding Issues Report accurately and timely• Successfully completed the Management Fundamentals Program as the first in Independent Health history• Successfully completed the Career Pathways Program in 2015• Successfully complete Medicare application audits at 100% each month• Extensive knowledge of Commercial Benefits, State Products, Coordination of Benefits, Claims Adjudication, CPT, ICD-9, ICD-10, Worker’s Compensation and No Fault• Maintain the privacy and security for all members• Consistently deliver the “Red Shirt Treatment” and living the Core Values of Independent Health

• Ensured integrity for Medisource and Family Heath Plus eligible members• Monitored error reports from our monthly Primary and Secondary Rosters• Performance Metrics were all met by the end of 2012 completing an average of 394 Service Requests a month in less than 1 day. Macess data entry (manually) on average completed 354 documents per month at an average hourly rate of 30 documents per hour • Re-wrote the Medisource and Family Health Plus Manuals with the training department• Auto assigned Primary Care Providers to Medisource and Family Health Plus members that did not choose their own in the 30 day time period allotted • Communicated with various departments responding to Siebel Service Requests • Processed daily newborn information• Completed terminations of Child Health Plus members • Frequent communication directly with Erie and Niagara County Department of Social Services to resolve discrepancies• Supported all other Operations Departments as needed

• Provided exceptional customer service and consistently met or exceeded monthly quality metrics• Educated members on benefits, eligibility, claims, Explanation of Benefits and authorizations • Followed up with member call backs and requests in a timely manner• Performed quality review of demographic changes and Primary Care Provider updates• Updated members with procedure and policy changes• Managed Fulfillment Bucket in sending out correspondence• Performed scanning and data entry for Fulfillment department regarding deceased members returned mail

• Managed the processing of business form orders and Rx Pads accurately and timely• Successfully managed customer complaints and issues timely and effectively with resolution• Handled all client and customer requests accurately and timely• Managed set up and supervised all website profiles for Tax Form clients• Managed the production of sales orders for Bed Bath & Beyond• Managed the maintenance of Rx Pads and Farmers Insurance agent profiles and photos• Provided assistance and support for all other departments when needed

• Provided customer service and sales to new and existing clients• Client retention and enhancing customer relationships• Sales representative • Processed applications for all products • Mentor and Training assistant with New Hires• Member of the “Change Management Team;” responsible for providing positive reinforcement to co-workers regarding changes in the workplace and bringing any questions or concerns to management