Tom Lightsey Email & Phone Number

Lexington, Sc, Us

Columbia, South Carolina Metropolitan Area

Based In The Southeast

I now work on the National Critical Response Team as a Project Manager. I work with all Community and State based groups all over the US. I resolve issues with State governments and work to build resources within UHG to provide business solutions.

Columbia, South Carolina Area

I work with SC DHHS reporting for Medicaid. I use provider data, claims data, network data and contract analysis to establish membership service levels and contract compliance.

I now work to grow Medicaid membership in practices in GA, NC and SC. I also work to resolve any concerns physicians may have with the Medicaid Process including claims, credentialing, formulary, reimbursement, EMR, EMH, HIPPA, ARRA and community outreach.

Individual and group physician prescription analysis and education. PDL format and editing, pharmacy contracting

My marketing analysis showed where we could save $100k a month in our drug purchases and moved to a position where training others-2 field marketing representatives on how to obtain, maintain and retain Primary Care Physicians in a Medicaid network..Expanded program to 11 representatives statewide and achieved 16.7% growth in 2010

Promoted in under a year in a recession after several successful presentations to South Carolina DHHS director (then Emma Forkner) and work with local community organizations. Analysis of pharmacy trends using PBM data has enabled us to increase the satisfaction of pharmacists, physicians and members in our network and save 1% or about 20k monthly on operating costs.

Brought pharmacy perspective to Unison's provider relations department. Contract negotiations with pharmacies, Home Medical Equipment and physicians throughout SC, and parts of NC and GA. Cleaned up the Medicaid line of business by analysis and weekly site visits. Streamlined the LOMN/PA process, added identifying data to reports for easier understanding and made presentations at several community organizations. Attended SC Medicaid meetings as Unison's representative and filed reports on state regulatory actions.

I manage all pharmacy contracts, reimbursements, member issues and analysis for over 1600 pharmacies. I also serve in the same capacity for DME.

Achievements: Increasing efficiency and sales for private practice- pharmacy. Trained 15 staff in local marketing, trained 35 staff in web site set up and utilization, made presentations to LTC facilities to increase market share by 3%. Pricing recommendations to offset drug cost increases with generic utilization and technology upgrades for third party billing.LTC, assisted living and private practice presentations.Responsibilities: serving multiple clients in the Mid-Lands of South Carolina. Auditing, analysis of pharmacies, dental and physician offices. Recommending technical and marketing strategies to operate efficiently in today's market. Inventory control, staffing, training and promotions. Budgets of 2-3 million per site 35 sites in all.

Achievements: Operating systems upgrades at 85% of clients Sales of 75 million (14% increase) Responsibilities: District, regional and national presentations on financial growth. Managed health care audit and contract negotiations Evaluation of existing operating efficiencies Sales of systems (sold 28 at 21,000 each) and systems upgrades Training of field locations implementing all technology solutions Develop and maintain relationships with investors, healthcare professionals, and government regulators and managed health care providers.

Sold B2B solutions such as inventory control, operating systems and wholesale drugs.

Served as account manager for individual pharmacies in 3 states. Helped with stafing, inventory, TPA, claims, regulatory needs and audit.

Oversaw operations at independent pharmacies

Sales Management, Closing, Contract Negotiation

Ba, Spanish/Business

Activities and Societies: Linda Lake Scholarship winner 3 years in a row. Sigma Delta Phi