Customer Service Quality Assurance

**** ****** ***** ***** **** O Lakes, Fl ***** . abnmfm@r.postjobfree.com . 813-***-****

BRIAN W BACHMAN, CPhT, CNPR

Excellent Work Ethic, Self-motivated, Innovative,

Resourceful, Attention to Detail, Results Oriented, Leader,

Claims Specialist, Project Management, Quality Assurance

RECENT ACCOMPLISHMENTS

Created and implemented manual claims processing procedure for claims received through the mail including:

universal claim forms, claims indicated to force a payment by bypassing specific edits as deemed by the

Agency for Healthcare Administration, unit dose returns, voids, and adjustments.

PROFESSIONAL EXPERIENCE

First Health Services, Tallahassee, Fl January 2008 – May 2009

S upervisor, Pharmaceutical Services Operations

Lead a diverse team of Customer Service Representatives and Certified Pharmacy Technicians in

the administration of Florida Medicaid pharmacy benefits by providing pharmacy and clinical

support for the adjudication of claims and obtaining prior authorizations for non-preferred and

clinical medications.

Monitored Avaya CMS to ensure agent availability and efficient use of time in order to exceed

service level agreements; instituted an after call limit of 1 minute per call average and a cascading

break schedule to insure adequate phone coverage saving approximately $35,000 per year.

Independently examined and analyzed the team’s performance against measured service

operational goals; identifies productive improvement areas and implements policy to increase

productivity such as the use of pre-written fax back responses.

Served as subject matter expert on prior authorization criteria for non-preferred and clinical

medications and claim adjudication logic to the call center staff, management, and the provider

community.

Performed quality assurance reviews on faxed prior authorization requests and recorded or live

calls in order to provide a high level of customer service and to maintain consistency among the

call center staff.

Researched issues as assigned by the Contract Manager, Clinical Account Manager or the Agency

for Health Care Administration in response to difficult inquiries including, but not limited to,

authorization, payments, denials, coordination of benefits, and eligibility; interfaced with the

customer and client by telephone, correspondence and/or in person to resolve concerns.

Medicaid Program Integrity, Tallahassee, Fl March 2005 – August 2005

Pharmacy Technician

Identified prescription billing errors and contacted pharmacies to achieve a reversal of

medications billed. Divisional goal of $350,000, personally recovered $500,000 within 4 months.

Compiled evidence of fraud and researched potential fraud candidates. Duties included

researching provider's Medicaid application, pharmacists’ licenses and any recent claims filled by

the provider.

Developed an evidence book according to internal guidelines, which documented the fraud. This

evidence book was well received and was used in actual cases.

Created and maintained spreadsheets and documentation of fraud in the FACTS computer

system. Re-organized existing spreadsheets for ease of use.

3450 Golden Eagle Drive Land O Lakes, Fl 34639 . abnmfm@r.postjobfree.com . 813-***-****

Tampa General Hospital, Tampa, Fl May 2004 – December 2004

Pharmacy Technician

Received, processed insurance and filled prescriptions daily to be presented to the Pharmacist for

review.

Reorganized the outpatient pharmacy so that drugs were more easily located and revamped the

drug organizational procedure. This organization plan was well received and was also

implemented in the main pharmacy, which resulted in a faster pull time, and less time spent

stocking the shelves with an estimated savings of $35,000.

Maintained inventory control and developed a universal schedule and procedure for ordering

drugs each day to make sure the pharmacy was stocked correctly.

Compounded specialty medications for patients.

Managed and serviced the Proscript prescription robot by restocking medication, vials, and

following operational procedure.

Walgreens Pharmacy, Miami, Fl August 2000 – November 2003

Pharmacy Technician

Assisted Pharmacists in daily activities

Received, processed insurance, and filled 500-800 prescriptions daily to be presented to the

Pharmacist for review

Ran the pharmacy on the weekends during which the pharmacy was never backed up and work

went smoothly.

Maintained inventory control and kept a clean work environment

Achieved Certification by the Pharmacy Technician Certification Board

EDUCATION

Florida State University May 2008

Bachelor of Science

Social Science

Pharmacy Technician Certification Board March 2008

Certified Pharmacy Technician

National Association of Pharmaceutical Representatives August 2009

Certified National Pharmaceutical Representative

ACHIEVEMENTS

August 2009: Member of the National Association of Pharmaceutical Representatives (NAPRX)

October 2004: Miracle Worker Honor from Tampa General Hospital Pharmacy Department

February 1998: Rank of Eagle Scout from the Boy Scouts of America

Contact this candidate