LUCKY ANGELA R. VAIL

Collaborate with different teams

Conduct training sessions

Assist/Guide Implementers

Data Analysis

Data Gathering

Provide timely and accurate support to different teams

Qualitative and Quantitative Data Collection

Evaluation of benefit programs

Analyzation of data pricing and regulations to ensure the pharmaceutical benefits are aligned with the needs of patients and the financial goals of the healthcare otganization.

• 1
• Analyze benefit requests and secure all necessary data to ensure appropriate implementation based on applied logic of pharmacy claim adjudication system
• 2
• Work with Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system
• 3
• Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system
• 4
• Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system
• 5
• Ensure timely communication of any issues and/or information needed to complete a plan request
• 6
• Develop client specific implementation plans and manage implementation processes in accordance with department protocol
• 7
• Run queries out of the adjudication system to secure all necessary information to implement plan requests
• 8
• Develop and run macros to implement plan requests
• 9
• Perform claim testing to ensure accurate claim adjudication
• 10
• Maintain acceptable and appropriate quality levels and production turn-around time
• 11
• Adhere to all documentation standards within the department
• 12
• Assist with the development of process improvements for the department