Manager Customer Service

*************@*****.**

STEPHANIE A. SMITH m 614-***-****

**** ********* *** #*, *** Diego, CA 92116

Objectives

Service centered and goal oriented professional. Seeking a long-term career in a Client or Employee Relations role

that allows me to contribute my experience in building and maintaining strong client relationships that produce

effective outcomes for both the organization and the client.

Professional Assets

*9+ years of seasoned knowledge within the Health & Wellness industry in service positions with direct customer

and client interaction. *5+ years of corporate experience with data analysis, strategic planning and project

management. *Charismatic presenter and effective communicator *Accomplished negotiator *Well versed in

Managed Care fundamentals and cost saving programs within the Medicare, Medicaid and commercial populations

*Passionate about providing excellent customer service while exceeding company goals, as well as meeting

customers’ needs *Ability to build quick rapport *Interpret and effectively communicate benefits and account

information to Clients, Members and Health Care Professionals *Skilled in providing coaching, training and

program implementation within small to large groups * Solve conflict with reason and a strategic approach. *Self-

starter * Proficient in Microsoft Outlook, Excel, Word, Power Point, Visio and Salesforce.

Experience

Program Design Administrator, Account Management, MedImpact, San Diego, CA.

MedImpact: Transparent Prescription Benefit Manager

July 2011 to present

Participates as a core member of the client team. Working closely with Account Executives and other

Account Managers in a collaborative effort to service the Client.

Develops project plans, coordinates & effectively communicates project status and fundamentals internally

and with Clients externally.

Manages a book of business consisting of 75% new accounts and 25% of regained Client accounts.

Including Medicaid, Medicare (Mcal), Commercial. Several individual lines of business effecting

membership totaling 50,000+.

Supporting the implementation team with new programs. Organizes daily, weekly and monthly project and

task plans. Utilizing project management tools to assist with goals, time lines and deadlines (Visio, Project

Manager, Excel).

Focuses on solving conflict with reason and strategic initiative.

Supports and helps manage an average of 10-15 Clients on a daily, weekly and yearly basis.

Suggests new strategies and approaches with current accounts. Efficient liaison with internal departments to

ensure a task is completed timely and with the true intent.

Provide ongoing quality checks and follow ups on current and newly implemented projects for top accounts to

retain Clients and earn repeat business.

A member of the Plan Standards Development team. Design work flows, plan standards and procedures.

Appeals and Grievances Coordinator, American Specialty Health, San Diego, CA.

American Specialty Health: The Nation’s leading specialty benefits organization.

February 2009 to July 2011

Organized the coordination and processing of grievances and appeals according to Client and state-specific

arrangements, guidelines and laws.

Created investigational cases while collaborating with the Clients, Members and Providers involved.

Researched and clearly reiterated benefits to involved Members, tactfully advising Providers of their

contractual obligations and communicating resolution results to Clients.

Educated potential Providers of Chiropractic, Acupuncture, Massage Therapy and Naturopathy about various

ASH specialty benefit programs.

Drafted and presented provider proposals.

*************@*****.**

STEPHANIE A. SMITH m 614-***-****

Tactfully advised Providers and Members of the appeal outcomes.

Provided detailed documentation on each account in a CRM database.

Managed Care Administrator, Program Implementation, Medco Health (PBM), Dublin, OH,

Medco Health: A Prescription Benefit Manager and mail service pharmacy; managing prescription benefits for

clients and their health care companies.

Dec. 2006 to Nov. 2008

Received and initiated calls concerning current coverage and Clinical guidelines on prior authorizations for

prescriptions with prescribers and medical office staff.

Built and processed clinical coverage reviews for medications along with detailed attention to individual plan

requirements.

Conducted new hire trainings to ensure successful onboarding process, one-on-one coaching and

performance reviews.

Worked collaboratively with other internal departments to provide client support and managed assigned

accounts.

Managed Care Coordinator, Prior Authorization, Medco Health (PBM), Dublin, OH

Medco Health: A Prescription Benefit Manager and mail service pharmacy; managing prescription benefits for

clients and their health care companies

April 2004 to Dec. 2006

Partnered alongside registered pharmacists to assist the needs of contacted doctors and health care

facilities.

Advised and educated health care professionals of high costing medications and possible drug class

alternatives in efforts to reduce the current cost of health care for Members, Clients and health care

professionals.

Clarified prescriptions questions, typing labels for current prescription orders.

* Awarded (2nd place) Marketing photo ad contest for Medco’s national newsletter and paper print ads

Education

Columbus State Community College, Columbus, OH. Fall 2004-2007

Hilliard Darby High School, Hilliard, OH, Graduated with subjects of focus; Art, English and Business.

Graduated: June 2000.

References Available Upon Request

LinkedIn page: http://www.linkedin.com/profile/view?id=204556869&trk=nav_responsive_tab_profile_pic

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