Clinical Pharmacy Operations

Pharmacy Benefit Quality

Directly assist with analysts in researching and resolving all grievances. Reporting and metrics driven.

I am experienced in prescription claims in all aspects. I am knowledgeable in claims review and resolution. I research and address issues and questions from pharmacies, members and customer service.I also have a strong background in the clinical department of a PBM. While on the clinical team, I worked with processing prior authorization, non-formulary, step therapy, quantity limit and appeal requests. We work with both Medicare part D and commercial plans and I work closely with the formulary manager and I have gained extensive knowledge in administration of both types of prescription plans.Currently, I assist with claims investigation with our compliance team. I also work with a team that is responsible for implementation of any new groups our company acquires.