Work History

Work History
Nov 2009 - Present

Pharmacy Claims Analyst

WELLCARE INSURANCE

• Tripled the Company’s Net Income to $2M of state contracts.

• Increased Gross Revenues from $4 to $6M of project management.

• Negotiated increased Reimbursement Rates from vendors by 10%.• Reduced Medicare/Medicaid – HMO/PPO/PFFS annual liability insurance premiums $800K.

• Prepare over 25 orders daily; verified prescription dosage and quantity to be dispensed.

Track 100+ daily activity logs of departmental activities.

Nov 2007 - Nov 2009

Account Management

HUMANA INSURANCE COMPANY, Tampa, FL

(Claims, Billing, Pharmacy, Enrollment, Benefits & Eligibility)

·Managed applications networking orders for over 13,000 nationwide customers.

·Assessed over 500 high volume vendor accounts.

·Computed & resolved billing & enrollment at 100% accuracy.

·Improved over 50+ Medicare/Medicaid individual/group health insurance by customizing.

·Marketed with 20 companies across industries; council 25 benefit packages for our clients.

·Prioritized up 20 daily follow-ups to ensure timely resolution.

·Evaluated an average of 25 problems to the customer’s satisfaction.

·Emphasized to members and providers on the values of over 85 products and services by up sales.

Apr 2004 - Oct 2007

Accounting Analyst

COCA-COLA ENTERPRISES, INC

·Saved $4M+ through negotiations with vendors about variances in write-offs.

·Audited 200 invoices monthly; generated/sent 50 reports monthly for financial reconciliation.

·Supervised the disbursement of $100M+ over 5 years for Canadian office support.

·Managed a major project which balanced 80 neglected and critical, large accounts.

·Eliminated double payments of invoices; created a tracking database for report correlation.

Education

Education

Master of Science, Business Administration

Nova Southeastern University

Skills

Skills

AS/400

Microsoft Dynamics Great Plain, Project, Visio

Microsoft Office Suite

SQL Design and relational database

FICO (SAP/R3 Pinnacle & Legacy)

Summary

A dynamic and well educated (MBA); Healthcare Management Analystwith three (3) years in pharmacy claims; three (3) years as a Financial Analyst;

Following are hard hitting, bottom lineaccomplishments:

  • Tripled the Company’s Net Income to $2M for state contracts
  • Increased Gross Revenues from $4 to $6M for project management
  • Negotiated increased Reimbursement Rates from vendors by 10%
  • Reduced annual liability insurance premiums $800K
  • Managed systems and applications networking orders support for over 13,000 U.S. customers representing a business value of $750 million
  • A hands-on, self motivated, results oriented, leader
  • Management/business development skills; increased Net Income a minimum of 15%

Interest

Personal level:

Sight seeing

Long walk on the beach

Walking

Dancing

Professional level:

  • Career opportunities
  • New ventures
  • Job inquiries
  • Expertise requests
  • Rference requests
  • Certifications

    Certifications

    Certification in Pharmacy

    Sanford-Brown Institution