Pharmacy Benefit Administrator/Credentialing Specialist Resume
LOG IN OR REGISTER TO CONTACT ME
This button will open the login/register page in a new tab. After logging in, come back to this page and refresh your browser.
Resume:
Pharmacy Benefit Administrator/Credentialing Specialist
A highly motivated individual with a proven track record of providing top quality work and advancing within an organization. Demonstrates strong communication and human relation skills. Proven records of success, producing high quality work under stressful conditions. An individual with responsibility and dependability to work independently or within a team management environment. Resourceful professional with nineteen years of increasingly accountable organizational roles.
Professional Experience
Health First TPA, Houston, TX - Pharmacy Benefit Administrator
&#; Responsible for implementing the ID card process. The ID card process was mocking up each ID card, both Medical & Dental for each Member. This process included setting up a draft of data information to be used on the ID card
&#; Responsible for mock up, sending ID card to vendor for approval. Vendor would mock up the ID card and send it back for approval. Once approved the ID cards would be printed and mailed out to the Members/Clients
&#; Attending pharmacy conferences and working closely with several PBM’s. Stayed up-to-date on new drug availability by attending several out of state pharmacy conferences and working closely with the PBM’s.
&#; Worked closely with Account Managers to keep them abreast of cost saving measures for clients, i.e., considering generics first, implementing specialty pharmacy for bio drugs and pill splitting.
Health Administration Services, Inc.
Credentialing Coordinator
&#; Credentialing of approximately , physicians for our in-house PPO network, Premier
&#; Evaluate provider needs in a specific geographic location or area of specialty and solicited providers as needed
&#; Responsible for maintaining and updating information on these physicians
&#; Scheduled and prepared a credentialing meeting for news physicians twice annually
&#; Accessing the National Practioners Databank; checking litigation on the physicians before presenting them to the PPO Board of Directors
&#; Develop, distribute and maintain PPO directories
&#; Responsible for formatting, proofing and setting up the directory for print
&#; Process letters to providers who are referring out-of-network or ae not in compliance with claims guidelines
&#; Assist in the maintenance of provider contract files
Health Administration Services, Inc. Eligibility
&#; Updated eligibility for members
&#; Updated student status on dependents
&#; Communicated any changes daily with the clients
Health Administration Services, Inc.
Client Services/Mailroom
&#; Opening and day stamping each piece of mail
&#; Refiling claims
&#; Copying files for Stop Loss claims
&#; Back-up for all outgoing mail and checks
&#; Delivering mail throughout the company
&#; Relieving the Receptionist for breaks and lunch
Accomplishments
Medical Terminology
Word
Access
Excel
Exceptional Assistant Seminar
Education
John H. Reagan High School, Houston, TX. Obtained High School Diploma
Earlier Career Summary
Receptionist, X-ray Department Park Plaza Hospital
Houston Police Dispatcher
