Senior Clinical Consultant / Pharmacist Manager
Subject matter expert in Reviews and Appeals product management. Point-of-contact for account team and client calls regarding reviews, appeals and drug coverage. Leveraged pricing, cost savings and client upsell in partnership with functional areas.
- Retained clients and sustained new customer upsell, advising for installations, issue resolution and correct setup.
- Grew profit margin building productive patient and physician relationships, resolving issues, updating and changing available products, attracting more clients.
- Met and exceeded company objectives enhancing client satisfaction, improving organizational effectiveness and productivity.
- Developed and updated existing pharmacy system capturing client intent for drug coverage and benefit review.
- Aided in streamlining and simplifying installation process for account teams, developing updated system for capturing client intent.
- Designed and maintained client-facing documents and review and appeal standard operating procedures, reducing necessity for meetings and calls.
- Guaranteed audit readiness and eliminated risk of fines, aligning reviews and appeals product with relevant regulations and standards.
- Responded to inquiries and resolved issues surrounding healthcare reform (ACA) compliance and Medicare Part D, maintaining adherence with state and federal regulations.
- Revised and customized standard appeal letters to fit specific clients, addressing individual client needs.
- Determined product financial impact and future projections using review and appeals book of business numbers.